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General NPI Number Information
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NPI Number | 1700338407
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Entity Type | Individual
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Provider Name | KRYSTAL COUTCHER PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 535 CENTERVILLE RD
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City | WARWICK
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State | RI
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Zip | 02886-4486
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Country | US
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Telephone | 800-659-5411
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Fax |
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Provider Business Mailing Address
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Address Line | 489 COMSTOCK PKWY
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City | CRANSTON
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State | RI
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Zip | 02921-2345
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Country | US
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Telephone | 203-800-5567
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01257
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 23.003718
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License Number State | CT
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