Healthcare Provider Details

I. General information

NPI: 1164850566
Provider Name (Legal Business Name): KRISTIN ANN CORDREY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KINGS HWY SUITE 103
LEWES DE
19958-1192
US

IV. Provider business mailing address

20714 ANNONDELL DR
LEWES DE
19958-7305
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-7050
  • Fax: 302-645-8473
Mailing address:
  • Phone: 860-895-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0000913
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: