Provider Demographics
NPI:1033773478
Name:PACIOCCO, KRYSTA LIN (ARNP)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:LIN
Last Name:PACIOCCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N PEARL ST STE 405
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2550
Mailing Address - Country:US
Mailing Address - Phone:253-752-8822
Mailing Address - Fax:253-752-5400
Practice Address - Street 1:2102 N PEARL ST STE 405
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2550
Practice Address - Country:US
Practice Address - Phone:253-752-8822
Practice Address - Fax:253-752-5400
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60909562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine