Provider Demographics
NPI:1306905476
Name:CRIST, VERONICA KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:KATHERINE
Last Name:CRIST
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 1:532 PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-9421
Mailing Address - Country:US
Mailing Address - Phone:402-316-8274
Mailing Address - Fax:
Practice Address - Street 1:430 MAIN ST W
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3414
Practice Address - Country:US
Practice Address - Phone:304-469-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1875363A00000X
MO2012033508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R38279Medicare UPIN
NE237182OtherFRHS MIDLANDS CHOICE
R38279Medicare UPIN
R38279Medicare UPIN