Provider Demographics
NPI:1831748060
Name:NIGHTINGALE, KYRA FETCHINA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:FETCHINA
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9701
Mailing Address - Country:US
Mailing Address - Phone:570-815-7411
Mailing Address - Fax:
Practice Address - Street 1:822 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9701
Practice Address - Country:US
Practice Address - Phone:570-815-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider