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General NPI Number Information
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NPI Number | 1063702116
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Entity Type | Individual
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Provider Name | KRISTY ELAINE MATSCHULLAT PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1780 E BULLARD AVE
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City | FRESNO
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State | CA
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Zip | 93710-5861
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Country | US
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Telephone | 800-492-4227
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Fax | 559-646-3652
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Provider Business Mailing Address
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Address Line | 2100 POWELL SREET SUITE 900
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City | EMERYVILLE
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State | CA
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Zip | 94608-1803
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Country | US
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Telephone | 510-350-2600
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Fax | 510-879-9100
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0006468
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License Number State | CO
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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 | PA0604
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085003971
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA64279
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License Number State | CA
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