Provider Demographics
NPI:1467893602
Name:HOLTERMAN, KRYSTA COSENTINO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTA
Middle Name:COSENTINO
Last Name:HOLTERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KRYSTA
Other - Middle Name:JENNINGS
Other - Last Name:COSENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11650 ALPHARETTA HWY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3805
Mailing Address - Country:US
Mailing Address - Phone:704-272-3880
Mailing Address - Fax:
Practice Address - Street 1:8300 HEALTH PARK STE 221
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:704-272-3880
Practice Address - Fax:704-208-4159
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant