Individual provider Active NPI

Gwyn M. Vernon, MSN, CRNP

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1104896240
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
TP003377B Issued in PA
Practice address
330 S 9TH St
Philadelphia, PA 19107-6153
Phone
(215) 829-6500
NPI assigned
Jan 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X TP003377B PA Primary

Addresses

Primary practice location

330 S 9TH St
Philadelphia, PA 19107-6153

Mailing address

330 S 9TH St
Philadelphia, PA 19107-6153
Phone (215) 829-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
TP003377BPAMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438214400000",
    "number": "1104896240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 S 9TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076153",
            "telephone_number": "215-829-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 S 9TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076153",
            "telephone_number": "215-829-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERNON",
        "first_name": "GWYN",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "MSN, CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-23",
        "last_updated": "2015-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "TP003377B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.