Provider Demographics
NPI:1568831477
Name:FUNYAK, KIRSTIE ELLEN (PA-C)
Entity type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:ELLEN
Last Name:FUNYAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIRSTIE
Other - Middle Name:ELLEN
Other - Last Name:KEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3824 NORTHERN PIKE STE 525
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2177
Mailing Address - Country:US
Mailing Address - Phone:412-373-6666
Mailing Address - Fax:412-373-4595
Practice Address - Street 1:3824 NORTHERN PIKE STE 525
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2177
Practice Address - Country:US
Practice Address - Phone:412-373-6666
Practice Address - Fax:412-373-4595
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057875363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103404788Medicaid
PA2S7140OtherMEDICARE