Provider Demographics
NPI:1578374021
Name:CERVONE, KYRA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:CERVONE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-804-5195
Mailing Address - Fax:724-804-5980
Practice Address - Street 1:529 LLOYD AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1721
Practice Address - Country:US
Practice Address - Phone:724-804-5195
Practice Address - Fax:724-804-5980
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032130163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse