MEDICARE: MS. KRISTIN MARIE BERKA PA-C

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	363A00000X	Physician Assistant	1109	SC
2	363AM0700X	Medical Physician Assistant	103380	NC
3	363A00000X	Physician Assistant	103380	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85246	OTHER	NC	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609837814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN MARIE BERKA PA-C

Provider Business Mailing Address
First Line	:	1563 HEALTHCARE DRIVE
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3858
Country	:	US
Telephone Number	:	803-329-6030
Fax Number	:	803-329-6035

Provider Business Practice Location Address
First Line	:	15830 BALLANTYNE MEDICAL PL STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0762
Country	:	US
Telephone Number	:	704-341-0090
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	10/08/2020

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