Provider Demographics
NPI:1861893034
Name:BROWN-KISHBAUGH, JAIMA (CRNP)
Entity type:Individual
Prefix:
First Name:JAIMA
Middle Name:
Last Name:BROWN-KISHBAUGH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-791-2540
Mailing Address - Fax:717-791-2549
Practice Address - Street 1:2005 TECHNOLOGY PKWY STE 440
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9413
Practice Address - Country:US
Practice Address - Phone:717-791-2540
Practice Address - Fax:717-791-2549
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014168363LF0000X, 363L00000X
PARN587897163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102963932Medicaid
PA102963932Medicaid