Healthcare Provider Details

I. General information

NPI: 1306905476
Provider Name (Legal Business Name): VERONICA KATHERINE CRIST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MAIN ST W
OAK HILL WV
25901-3414
US

IV. Provider business mailing address

532 PEA RIDGE RD
OAK HILL WV
25901-9421
US

V. Phone/Fax

Practice location:
  • Phone: 304-469-8600
  • Fax:
Mailing address:
  • Phone: 402-316-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1875
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: