MEDICARE: MARCELA MARIE KRISTEK MPAS, 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	PA15343	TX

General Provider Information

NPI Number	:	1952053381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELA MARIE KRISTEK MPAS, PA-C

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEDICAL PKWY
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1791
Country	:	US
Telephone Number	:	512-654-1234
Fax Number	:

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

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	04/13/2022

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