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General NPI Number Information
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NPI Number | 1558963926
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Entity Type | Individual
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Provider Name | KRISTEN KOENIG PA
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Gender | Female
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 1 ATWELL RD
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City | COOPERSTOWN
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State | NY
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Zip | 13326-1301
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Country | US
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Telephone | 607-547-4934
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Fax |
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Provider Business Mailing Address
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Address Line | 8465 NUMBER 2 RD E
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City | MANLIUS
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State | NY
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Zip | 13104-8716
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Country | US
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Telephone | 315-720-6238
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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