Provider Demographics
NPI:1467641647
Name:COARASA, KRISTIE L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:L
Last Name:COARASA
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 1:653 N TOWN CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0516
Mailing Address - Country:US
Mailing Address - Phone:702-254-3020
Mailing Address - Fax:702-255-2620
Practice Address - Street 1:653 N TOWN CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0516
Practice Address - Country:US
Practice Address - Phone:702-254-3020
Practice Address - Fax:702-255-2620
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NVPA1148363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
BK848YOtherMEDICARE PTAN
BK848YOtherMEDICARE PTAN
NVBK848YMedicare PIN