Provider Demographics
NPI:1801263165
Name:WERT, KRISTI ANN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ANN
Last Name:WERT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KRISTI
Other - Middle Name:ANN
Other - Last Name:KOMYANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 BOWMAN DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9623
Mailing Address - Country:US
Mailing Address - Phone:856-751-7880
Mailing Address - Fax:856-751-9133
Practice Address - Street 1:4829 E. STREET RD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:215-364-5800
Practice Address - Fax:215-364-5899
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015277363LP0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics