Healthcare Provider Details

I. General information

NPI: 1043858574
Provider Name (Legal Business Name): KRYSTIN LEIGH KRISTOVENSKY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MARTIN AVE STE 320
EPHRATA PA
17522-1761
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-721-5800
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP0194419
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: