MEDICARE: MRS. KRISTINA RENAE TRUNNELL PA-C

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
1	363AM0700X	Medical Physician Assistant	C03102	MD

General Provider Information

NPI Number	:	1831313972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA RENAE TRUNNELL PA-C

Provider Business Mailing Address
First Line	:	5310 HARVEST HILL RD STE 290
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5826
Country	:	US
Telephone Number	:	214-420-0650
Fax Number	:	903-939-0755

Provider Business Practice Location Address
First Line	:	6550 MERCANTILE DR E STE 203
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-7657
Country	:	US
Telephone Number	:	240-422-8859
Fax Number	:	240-422-8862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	10/12/2023

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