Provider Demographics
NPI:1902161466
Name:KRYSA, DAWN MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:KRYSA
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 1:1211 S RESERVE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3102
Mailing Address - Country:US
Mailing Address - Phone:406-926-6722
Mailing Address - Fax:
Practice Address - Street 1:1211 S RESERVE ST STE 202
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3102
Practice Address - Country:US
Practice Address - Phone:406-926-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED-PAC-LIC-25709363AM0700X
MT25709363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty