Provider Demographics
NPI:1659665008
Name:BERZANSKY, KRISTI S (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:S
Last Name:BERZANSKY
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 1:4133 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BROAD TOP
Mailing Address - State:PA
Mailing Address - Zip Code:16621-9001
Mailing Address - Country:US
Mailing Address - Phone:814-635-2916
Mailing Address - Fax:814-635-2918
Practice Address - Street 1:4133 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BROAD TOP
Practice Address - State:PA
Practice Address - Zip Code:16621-9001
Practice Address - Country:US
Practice Address - Phone:814-635-2916
Practice Address - Fax:814-635-2918
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054878363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA054878OtherPA LICENSE NUMBER