Provider Demographics
NPI:1447211065
Name:KOONTZ, KRISTIN L (PA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CRAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2507
Mailing Address - Country:US
Mailing Address - Phone:724-550-6024
Mailing Address - Fax:
Practice Address - Street 1:1850 MCLAUGHLIN RUN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-2332
Practice Address - Country:US
Practice Address - Phone:412-221-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052153363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical