Provider Demographics
NPI:1649926916
Name:GAVERN, KATIE (MSN, CRNP, WHNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GAVERN
Suffix:
Gender:F
Credentials:MSN, CRNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 S WESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-5970
Mailing Address - Country:US
Mailing Address - Phone:508-926-9498
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD STE 170
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3234
Practice Address - Country:US
Practice Address - Phone:610-527-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01264600363LW0102X
PASP024454363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health