Provider Demographics
NPI:1225270796
Name:KRISTON, JESSICA ANNE (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:KRISTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:120 N FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-1321
Mailing Address - Country:US
Mailing Address - Phone:814-807-0072
Mailing Address - Fax:
Practice Address - Street 1:765 LIBERTY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-333-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology