Provider Demographics
NPI:1265685473
Name:EPPOLITE, KRISTEN NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:EPPOLITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:STONAKER-RICCIARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:479 THOMAS JONES WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2552
Mailing Address - Country:US
Mailing Address - Phone:610-280-9999
Mailing Address - Fax:
Practice Address - Street 1:479 THOMAS JONES WAY STE 300
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2552
Practice Address - Country:US
Practice Address - Phone:610-280-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant