Provider Demographics
NPI:1942784319
Name:SHORES, KRISTIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:SHORES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:
Other - Last Name:ROHRBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2323
Mailing Address - Country:US
Mailing Address - Phone:484-330-1377
Mailing Address - Fax:
Practice Address - Street 1:7096 DECATUR ST
Practice Address - Street 2:
Practice Address - City:NEW TRIPOLI
Practice Address - State:PA
Practice Address - Zip Code:18066-3815
Practice Address - Country:US
Practice Address - Phone:610-298-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060130207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA060130OtherSTATE LICENSE