MEDICARE: KRISTA L RAFFERTY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	MA054693	PA
2	363A00000X	Physician Assistant	MA054693	PA

General Provider Information

NPI Number	:	1073815437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA L RAFFERTY PA

Provider Business Mailing Address
First Line	:	5615 YORK RD
Second Line	:
City	:	NEW OXFORD
State	:	PA
Zip	:	17350-9553
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 YORK RD
Second Line	:
City	:	NEW OXFORD
State	:	PA
Zip	:	17350-9553
Country	:	US
Telephone Number	:	717-624-1337
Fax Number	:	717-624-1795

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	04/09/2021

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Directions to “ KRISTA L RAFFERTY PA” Practice Location

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