Provider Demographics
NPI:1265683502
Name:HATFIELD, KRISTEN M (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:BISSONETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQUARE
Mailing Address - Street 2:4 BLUE GENERAL SURGERY GUTHRIE CLINIC
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-6666
Mailing Address - Fax:570-887-2338
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-2079
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002815363AS0400X
PAMA054821363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03326170Medicaid
OH7418941Medicare PIN
PA215525Medicare PIN
NY03326170Medicaid
OH32131Medicare PIN