Provider Demographics
NPI:1811372626
Name:SALATA, KRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SALATA
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 1:980 N WALNUT CREEK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8020
Mailing Address - Country:US
Mailing Address - Phone:817-473-9473
Mailing Address - Fax:817-473-3473
Practice Address - Street 1:980 N WALNUT CREEK DR STE 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8020
Practice Address - Country:US
Practice Address - Phone:817-473-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007409363A00000X
TXPA14324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant