Provider Demographics
NPI:1437795408
Name:HARTLEY, KRYSTA (PA-C)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:HARTLEY
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 1:45 POLO DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-8877
Mailing Address - Country:US
Mailing Address - Phone:814-504-1336
Mailing Address - Fax:
Practice Address - Street 1:1987 HILTON RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2968
Practice Address - Country:US
Practice Address - Phone:336-226-0848
Practice Address - Fax:336-226-6247
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9551363AM0700X
NC0010-12322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical