Basic Information
Provider Information | |||||||||
NPI: | 1023488608 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KLINE | ||||||||
FirstName: | JOELENE | ||||||||
MiddleName: | F. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SIDER | ||||||||
OtherFirstName: | JOELENE | ||||||||
OtherMiddleName: | F. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 220 WILSON ST | ||||||||
Address2: | STE 109 | ||||||||
City: | CARLISLE | ||||||||
State: | PA | ||||||||
PostalCode: | 170133697 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172491929 | ||||||||
FaxNumber: | 7172499332 | ||||||||
Practice Location | |||||||||
Address1: | 3106 PHILADELPHIA AVE | ||||||||
Address2: |   | ||||||||
City: | CHAMBERSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 172018938 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172643644 | ||||||||
FaxNumber: | 7172649077 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/25/2015 | ||||||||
LastUpdateDate: | 09/06/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/06/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP015250 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 103057224 | 05 | PA |   | MEDICAID |