Provider Demographics
NPI:1538231915
Name:MCCORMICK, KRISTIN ELIZABETH (CRNP)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:SHIBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:804 SCOTT NIXON MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:701 E MARSHALL STREET
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4412
Practice Address - Country:US
Practice Address - Phone:610-431-5472
Practice Address - Fax:610-430-2914
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN523431L163W00000X
PA23814069172A00000X
PASP009046363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No172A00000XOther Service ProvidersDriver