Provider Demographics
NPI:1164850566
Name:CORDREY, KRISTIN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:CORDREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20714 ANNONDELL DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-7305
Mailing Address - Country:US
Mailing Address - Phone:860-895-3956
Mailing Address - Fax:
Practice Address - Street 1:750 KINGS HWY SUITE 103
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1192
Practice Address - Country:US
Practice Address - Phone:302-645-7050
Practice Address - Fax:302-645-8473
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant