Provider Demographics
NPI:1538937909
Name:OMLOR, KRISTEN M
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:OMLOR
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 1:13911 HARVIE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1656
Mailing Address - Country:US
Mailing Address - Phone:412-418-6999
Mailing Address - Fax:
Practice Address - Street 1:125 LOGANS FERRY RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-2048
Practice Address - Country:US
Practice Address - Phone:866-419-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN598636163W00000X
PASP028960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse