Provider Demographics
NPI:1831313972
Name:TRUNNELL, KRISTINA RENAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:RENAE
Last Name:TRUNNELL
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 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0650
Mailing Address - Fax:903-939-0755
Practice Address - Street 1:6550 MERCANTILE DR E STE 203
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7657
Practice Address - Country:US
Practice Address - Phone:240-422-8859
Practice Address - Fax:240-422-8862
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03102363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265111Medicare PIN