Healthcare Provider Details

I. General information

NPI: 1952311250
Provider Name (Legal Business Name): KRISTEN OSBORNE WOYTACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3336
  • Fax: 607-547-3891
Mailing address:
  • Phone: 607-547-3336
  • Fax: 76-547-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: