Basic Information
| Provider Information | |||||||||
| NPI: | 1477534600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERDI | ||||||||
| FirstName: | KRISTA | ||||||||
| MiddleName: | MICHELE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BEHNEY | ||||||||
| OtherFirstName: | KRISTA | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5445 LANARK RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | CENTER VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180348694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845265210 | ||||||||
| FaxNumber: | 8665686561 | ||||||||
| Practice Location | |||||||||
| Address1: | 5445 LANARK RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | CENTER VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180348694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845265210 | ||||||||
| FaxNumber: | 8665686561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2005 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9102906 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | MA055207 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 291922200 | 05 | FL | MEDICAID | 533760182A | 05 | GA | MEDICAID |