Provider Demographics
NPI:1851370209
Name:KANE, KRYSTLE (MSPA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:MSPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6206
Mailing Address - Country:US
Mailing Address - Phone:610-437-4134
Mailing Address - Fax:610-433-9690
Practice Address - Street 1:700 SCHUYLKILL MANOR RD STE 5
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3849
Practice Address - Country:US
Practice Address - Phone:570-622-6804
Practice Address - Fax:570-622-3385
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA096571GDKMedicare ID - Type Unspecified
PAQ58700Medicare UPIN