Provider Demographics
NPI:1285922492
Name:THOMAS, KRYSTAL M (PA-C)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:267-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:4 LIFE MARK DR
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1577
Practice Address - Country:US
Practice Address - Phone:215-453-4026
Practice Address - Fax:215-453-4719
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2020-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant