Provider Demographics
NPI:1265433379
Name:POTTS, KRISTINE GALLEY (CRNP)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:GALLEY
Last Name:POTTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:SHARON
Other - Last Name:GALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:AGH EMERGENCY ASSOCS
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-4138
Mailing Address - Fax:412-359-8874
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:AGH EMERGENCY ASSOCS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-4138
Practice Address - Fax:412-359-8874
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000379A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA586023NJRMedicare PIN
PA029497NJRMedicare PIN