Healthcare Provider Details

I. General information

NPI: 1659020626
Provider Name (Legal Business Name): KRISTINA NOELLE HARVEY PA-C, MPSAS, MSMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 OGDEN AVE
AURORA IL
60504-7597
US

IV. Provider business mailing address

2111 OGDEN AVE
AURORA IL
60504-7597
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-3800
  • Fax: 630-862-3085
Mailing address:
  • Phone: 630-978-3800
  • Fax: 630-862-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: