Provider Demographics
NPI:1053319855
Name:WASSEL, KRISTEN AGNES (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:AGNES
Last Name:WASSEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:AGNES
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2793 GERYVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-2306
Mailing Address - Country:US
Mailing Address - Phone:267-424-8005
Mailing Address - Fax:
Practice Address - Street 1:2793 GERYVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-2306
Practice Address - Country:US
Practice Address - Phone:267-424-8005
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050778363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1958792OtherHIGHMARK BLUE SHIELD
P3176072OtherOXFORD HEALTH PLANS
50047062OtherCAPITAL BLUE CROSS
328920OtherHEALTHAMERICA/HEALTHASSUR
50047062OtherKEYSTONE HEALTH CENTRAL
970022170OtherRAILROAD MEDICARE
PA055045Medicare PIN
328920OtherHEALTHAMERICA/HEALTHASSUR