Provider Demographics
NPI:1669078564
Name:MCGOWAN, KERI LEEANN (CRNP)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:LEEANN
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 BERNVILLE RD
Mailing Address - Street 2:STE G02
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9466
Mailing Address - Country:US
Mailing Address - Phone:610-378-2317
Mailing Address - Fax:610-898-5971
Practice Address - Street 1:2494 BERNVILLE RD STE G02
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9466
Practice Address - Country:US
Practice Address - Phone:610-378-2317
Practice Address - Fax:610-898-5971
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022773363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health