Basic Information
Provider Information
NPI: 1598791014
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLEECHER
FirstName: KAY-ELLA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1803 MOUNT ROSE AVE
Address2: STE B3
City: YORK
State: PA
PostalCode: 174033026
CountryCode: US
TelephoneNumber: 7178511405
FaxNumber: 7178516969
Practice Location
Address1: 1001 S GEORGE ST
Address2: YORK HOSPITAL EMERGENCY DEPARTMENT
City: YORK
State: PA
PostalCode: 174033676
CountryCode: US
TelephoneNumber: 7178512450
FaxNumber: 7178513469
Other Information
ProviderEnumerationDate: 06/25/2006
LastUpdateDate: 04/08/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XSP008102PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
156894001PAGATEWAY-WMGOTHER
5006724901PACAPITAL BLUE CROSS-YHOTHER


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