Provider Demographics
NPI:1740732452
Name:HERR, KAITLYN (CRNP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:HERR
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 1:1120 COCOA AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1712
Mailing Address - Country:US
Mailing Address - Phone:717-533-4141
Mailing Address - Fax:717-533-9797
Practice Address - Street 1:211 BROAD ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17053-1302
Practice Address - Country:US
Practice Address - Phone:717-957-3500
Practice Address - Fax:717-957-4069
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016744363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily