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General NPI Number Information
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NPI Number | 1821517574
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Entity Type | Individual
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Provider Name | KRYSTAL MARIE THAYER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 500 BURLINGTON RD
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City | JACKSON
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State | OH
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Zip | 45640-9360
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Country | US
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Telephone | 740-288-4625
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Fax |
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Provider Business Mailing Address
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Address Line | 759 STEWART AVE
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City | STREETSBORO
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State | OH
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Zip | 44241-4750
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Country | US
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Telephone | 330-221-0267
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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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