Provider Demographics
NPI:1730891474
Name:MUIR, KATHRYN JANE (PHD, FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANE
Last Name:MUIR
Suffix:
Gender:F
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 KINGSESSING AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3743
Mailing Address - Country:US
Mailing Address - Phone:202-213-1062
Mailing Address - Fax:
Practice Address - Street 1:1700 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1529
Practice Address - Country:US
Practice Address - Phone:215-454-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026704363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care