Provider Demographics
NPI:1437543618
Name:HERRYGERS, KRISTA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:HERRYGERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:610 N MICHIGAN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1077
Practice Address - Country:US
Practice Address - Phone:574-647-6500
Practice Address - Fax:574-647-6518
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001800A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01666309OtherRR MEDICARE
IN000000924930OtherBCBS BMG CARDIOTHORACIC SURGERY SB
IN000000924933OtherBCBS BMG CARDIOTHORACIC SURGERY ELKHART
INM59677003Medicare PIN
IN000000924933OtherBCBS BMG CARDIOTHORACIC SURGERY ELKHART