Provider Demographics
NPI:1447524533
Name:TRADER-KENT, DESIREE M (CRNP)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:M
Last Name:TRADER-KENT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 N BROAD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4105
Mailing Address - Country:US
Mailing Address - Phone:215-707-6144
Mailing Address - Fax:215-707-5901
Practice Address - Street 1:7604 CENTRAL AVE
Practice Address - Street 2:FRIEND HALL SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2433
Practice Address - Country:US
Practice Address - Phone:215-707-3133
Practice Address - Fax:215-728-4293
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily