Provider Demographics
NPI:1245430362
Name:KRISTUFEK, KARMA A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARMA
Middle Name:A
Last Name:KRISTUFEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 S HYLAND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-1039
Mailing Address - Country:US
Mailing Address - Phone:252-287-2689
Mailing Address - Fax:
Practice Address - Street 1:122 DEMAREE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-4622
Practice Address - Country:US
Practice Address - Phone:812-265-9191
Practice Address - Fax:812-265-1050
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000799A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN797310GGGMedicare PIN