Provider Demographics
NPI:1689826638
Name:BROUNCE, KRISTAL A (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:KRISTAL
Middle Name:A
Last Name:BROUNCE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4 GAZEBO PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938
Mailing Address - Country:US
Mailing Address - Phone:215-693-1199
Mailing Address - Fax:215-693-1197
Practice Address - Street 1:4 GAZEBO PLACE
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938
Practice Address - Country:US
Practice Address - Phone:215-693-1199
Practice Address - Fax:215-693-1197
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363A00000X
PAOA003287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant