Healthcare Provider Details

I. General information

NPI: 1609837814
Provider Name (Legal Business Name): KRISTIN MARIE BERKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15830 BALLANTYNE MEDICAL PL STE 100
CHARLOTTE NC
28277-0762
US

IV. Provider business mailing address

1563 HEALTHCARE DRIVE
ROCK HILL SC
29732-3858
US

V. Phone/Fax

Practice location:
  • Phone: 704-341-0090
  • Fax:
Mailing address:
  • Phone: 803-329-6030
  • Fax: 803-329-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1109
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103380
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103380
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: