Kirsten Ellen Bubb, CRNP
Individual provider Active NPI Nurse Practitioner · Lock Haven, PA
NPI 1134554751 · NPPES record last updated Nov 1, 2024
Key facts
- NPI
- 1134554751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- SP013148 (PA)
- Practice address
- 45 Bellefonte Ave
Suite #2
Lock Haven, PA 17745 - Phone
- (570) 858-5328
- Fax
- (570) 858-5355
- NPI assigned
- Sep 13, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Phoenix Rehabilitation and Health Services Inc
Haven Health and Wellness LLC
Practice addresses (Care Compare)
2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238
45 Bellefonte Ave
Suite 2
Lock Haven, PA 17745-1237
Phone (570) 971-7121
Hospital & facility affiliations
- Upmc Home Healthcare
- Upmc Williamsport
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131029000019 | PA | Practitioner - Nurse Practitioner | 9537394507 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN574721 | PA | MD | Registered Nurse |
| SP013148 | PA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Practice Center, PC | Nurse Practitioner | Current |
Accepting new patients |
| Haven Health and Wellness LLC | Current |
Accepting new patients | |
| Family Practice Center, PC | Current |
Accepting new patients |
Locations
45 Bellefonte Ave
#2
Lock Haven, PA 17745
Phone (570) 858-5328
45 Bellefonte Ave
Lock Haven, PA 17745
Phone (570) 337-3440
7 Dock Hill Rd
Middleburg, PA 17842
Phone (570) 837-2123
1205 River Ave
#1
Williamsport, PA 17701
Phone (570) 323-5991
Interoperability endpoints
- kirstenbubbcrnp@havenhealth.medentdirect.com
- kirstenbubbcrnp@fpc.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN574721 | PA | |
| Nurse Practitioner | 363L00000X | SP013148 | PA | Yes |
Addresses
Primary practice location
45 Bellefonte Ave
Suite #2
Lock Haven, PA 17745
Mailing address
45 Bellefonte Ave
Suite #2
Lock Haven, PA 17745
Phone (570) 858-5328
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103171980-0002 | Medicaid | PA | |
| 6Z2801 | Other | PA | MEDICARE PTAN |
Other names
- Kirsten Ellen Lazorka
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | KirstenBubbCRNP@fpc.medentdirect.com | Health Information Exchange (HIE) | FAMILY PRACTICE CENTER, PC |
Other providers in Lock Haven, PA
- Nevin Brooks
- Nieyana Alea Brooks
- Abby Lynn Brown
- Lynn A Bruner
- Michael T Bruning
- Shataya Leigh Buxton
- Jena Caprio
- Dominic Joseph Caputo
- Stefano R Carpenetti
- Haley Carpenter
All providers in Lock Haven, PA · Nurse Practitioner in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.