Healthcare Provider Details

I. General information

NPI: 1548350382
Provider Name (Legal Business Name): KRISTA CIVILETTI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FREEDOM PKWY STE C
PITTSBORO NC
27312-4939
US

IV. Provider business mailing address

2000 PERIMETER PARK DR SUITE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 919-545-0911
  • Fax: 919-545-0096
Mailing address:
  • Phone: 919-563-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012949
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-02119
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: