Provider Demographics
NPI:1548262090
Name:TREVATHAN, KRISTA J (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:J
Last Name:TREVATHAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2405 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3329
Practice Address - Country:US
Practice Address - Phone:859-278-9492
Practice Address - Fax:859-469-5461
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2024-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65926933Medicaid
S80267Medicare UPIN
S80267Medicare UPIN