Provider Demographics
NPI:1770110264
Name:BICKERT, KIRSTEN MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:MARIE
Last Name:BICKERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-9712
Mailing Address - Country:US
Mailing Address - Phone:484-506-9048
Mailing Address - Fax:
Practice Address - Street 1:828 CREEK RD
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-9712
Practice Address - Country:US
Practice Address - Phone:484-506-9048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN589911363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health