Individual provider Active NPI

Kathleen M Nissley, CRNP

  • Family Nurse Practitioner
  • Lancaster, PA
National Provider Identifier
1629374822
Registry record updated Jun 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP010969 Issued in PA
Practice address
217 Harrisburg Ave
Lancaster, PA 17603-2964
Phone
(717) 397-5484
Fax
(717) 397-8407
NPI assigned
Feb 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2017

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 SP010969 PA Primary

Addresses

Primary practice location

217 Harrisburg Ave
Lancaster, PA 17603-2964

Mailing address

217 Harrisburg Ave
Lancaster, PA 17603-2964
Phone (717) 397-5484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110527000428 PA Practitioner - Nurse Practitioner 7618154790 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Heart Group of Lancaster General HealthGroup PAC ID 1052507449, 62 clinicians

Practice addresses (Care Compare)

217 Harrisburg Ave
Lancaster, PA 17603-2962
Phone (717) 544-8300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP010969PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Heart Group of Lancaster General Health CurrentSince Feb 7, 2011 Accepting new patients
Lancaster General Hospital CurrentSince Mar 11, 2021 Accepting new patients
Lancaster General Hospital CurrentSince Mar 11, 2021 Accepting new patients
Lancaster General Medical Group Past Accepting new patients

Locations

217 Harrisburg Ave
Lancaster, PA 17603
Phone (717) 397-5484

555 N Duke St
Lancaster, PA 17602
Phone (717) 544-5945

Interoperability endpoints

  • Direct secure messaging: knissley20011@direct-lghealth.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1296777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497312000000",
    "number": "1629374822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 HARRISBURG AVE",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176032964",
            "telephone_number": "717-397-5484",
            "fax_number": "717-397-8407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 HARRISBURG AVE",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176032964",
            "telephone_number": "717-397-5484",
            "fax_number": "717-397-8407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSLEY",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-04",
        "last_updated": "2017-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP010969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

Verify at the official NPI Registry.