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NPI Code Detail

MEDICARE: KRISTOPHER MUSICK PA

MEDICARE: KRISTOPHER MUSICK PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant00776WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11069331OTHERWVWV DWC
2001719864OTHERWVBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1245216639
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTOPHER MUSICK PA
Provider Business Mailing Address
First Line : 4750 HEMPSTEAD STATION DR
Second Line :
City : KETTERING
State : OH
Zip : 45429-5164
Country : US
Telephone Number : 800-875-0136
Fax Number :
Provider Business Practice Location Address
First Line : 3200 MACCORKLE AVE SE
Second Line :
City : CHARLESTON
State : WV
Zip : 25304-1227
Country : US
Telephone Number : 304-388-4170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 11/13/2008

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Directions to “ KRISTOPHER MUSICK PA” Practice Location

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