Provider Demographics
NPI:1306327176
Name:KRISTOFOR, MATTHEW (CRNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KRISTOFOR
Suffix:
Gender:M
Credentials:CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 GASTON CAPERTON DR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:WV
Mailing Address - Zip Code:25625-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8001 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2908
Practice Address - Country:US
Practice Address - Phone:215-685-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019152363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health