Provider Demographics
NPI:1609837814
Name:BERKA, KRISTIN MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIE
Last Name:BERKA
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 1:1563 HEALTHCARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3858
Mailing Address - Country:US
Mailing Address - Phone:803-329-6030
Mailing Address - Fax:803-329-6035
Practice Address - Street 1:15830 BALLANTYNE MEDICAL PL STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0762
Practice Address - Country:US
Practice Address - Phone:704-341-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1109363A00000X
NC103380363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85246OtherBLUECROSS BLUESHIELD
NC7985246Medicaid
NC85246OtherBLUECROSS BLUESHIELD
NC7985246Medicaid