Provider Demographics
NPI:1861042913
Name:DESOMMA, KRISTY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:DESOMMA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:ZENTKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:213 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1375
Mailing Address - Country:US
Mailing Address - Phone:660-624-9952
Mailing Address - Fax:
Practice Address - Street 1:107 GAMMA DR STE 210
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2936
Practice Address - Country:US
Practice Address - Phone:412-963-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily