Provider Demographics
NPI:1386643674
Name:CHRISTMAN, KELLY ANN (RPAC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:CHRISTMAN
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GOLDENS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2810
Mailing Address - Country:US
Mailing Address - Phone:914-242-2020
Mailing Address - Fax:914-242-0690
Practice Address - Street 1:185 KISCO AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1409
Practice Address - Country:US
Practice Address - Phone:914-242-2020
Practice Address - Fax:914-242-0690
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009010363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5668L1Medicare ID - Type Unspecified
NYQ27473Medicare UPIN