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General NPI Number Information
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NPI Number | 1023650520
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Entity Type | Individual
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Provider Name | KRISTI XHAXHO KRIKRIS PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 385 W MAIN ST
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City | AVON
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State | CT
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Zip | 06001-4357
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Country | US
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Telephone | 860-777-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 776 LONGMEADOW ST
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City | LONGMEADOW
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State | MA
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Zip | 01106-2219
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Country | US
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Telephone | 413-565-4400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | PA7246
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004645
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License Number State | CT
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