Provider Demographics
NPI:1235697749
Name:DERR, KURSTYN T (PA-C)
Entity Type:Individual
Prefix:
First Name:KURSTYN
Middle Name:T
Last Name:DERR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KURSTYN
Other - Middle Name:T
Other - Last Name:PFLEEGOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 RIVERVIEW AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9140
Mailing Address - Fax:757-793-4149
Practice Address - Street 1:205 S FRONT STREET
Practice Address - Street 2:6TH FLOOR BMA
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1619
Practice Address - Country:US
Practice Address - Phone:717-988-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007261363A00000X
PAOA006245363A00000X
DE1157180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant