Provider Demographics
NPI:1073815437
Name:RAFFERTY, KRISTA L (PA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:L
Other - Last Name:GERLACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5615 YORK RD
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350-9553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5615 YORK RD
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9553
Practice Address - Country:US
Practice Address - Phone:717-624-1337
Practice Address - Fax:717-624-1795
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054693363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA339593FLTMedicare PIN