Provider Demographics
NPI:1255827473
Name:CARPER, KRISTIANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIANNE
Middle Name:
Last Name:CARPER
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 1:130 CRITCHLOW SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:RENFREW
Mailing Address - State:PA
Mailing Address - Zip Code:16053-9437
Mailing Address - Country:US
Mailing Address - Phone:724-316-4268
Mailing Address - Fax:
Practice Address - Street 1:130 CRITCHLOW SCHOOL RD
Practice Address - Street 2:
Practice Address - City:RENFREW
Practice Address - State:PA
Practice Address - Zip Code:16053-9437
Practice Address - Country:US
Practice Address - Phone:724-316-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0598672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry