Provider Demographics
NPI:1245425305
Name:ALLBRITTON, KRYSTAL (PA)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:ALLBRITTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9842 WESTOVER HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4321
Mailing Address - Country:US
Mailing Address - Phone:210-314-6557
Mailing Address - Fax:757-229-2692
Practice Address - Street 1:9842 WESTOVER HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4321
Practice Address - Country:US
Practice Address - Phone:210-314-6557
Practice Address - Fax:210-314-6559
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140457OtherANTHEM
VA213427OtherCIGNA
VA121242OtherSOUTHERN HEALTH
VA432612OtherUNITED HEALTHCARE
VA54536OtherSENTARA/OPTIMA
VA5209080OtherAETNA
VA432612OtherUNITED HEALTHCARE