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NPI Code Detail

MEDICARE: KRYSTAL COUTCHER PA-C

MEDICARE: KRYSTAL COUTCHER 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
1363AM0700XMedical Physician AssistantPA01257RI
2363AM0700XMedical Physician Assistant23.003718CT

General Provider Information

NPI Number : 1700338407
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL COUTCHER PA-C
Provider Business Mailing Address
First Line : 489 COMSTOCK PKWY
Second Line :
City : CRANSTON
State : RI
Zip : 02921-2345
Country : US
Telephone Number : 203-800-5567
Fax Number :
Provider Business Practice Location Address
First Line : 535 CENTERVILLE RD
Second Line :
City : WARWICK
State : RI
Zip : 02886-4486
Country : US
Telephone Number : 800-659-5411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2016
Last Update Date : 12/11/2025

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Directions to “ KRYSTAL COUTCHER PA-C” Practice Location

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