Provider Demographics
NPI:1548350382
Name:CIVILETTI, KRISTA (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:CIVILETTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:919-563-2896
Mailing Address - Fax:
Practice Address - Street 1:75 FREEDOM PKWY STE C
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-4939
Practice Address - Country:US
Practice Address - Phone:919-545-0911
Practice Address - Fax:919-545-0096
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012949207Q00000X
NC2014-02119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCP490BOtherMEDICARE PTAN
NCNCP490BOtherMEDICARE PTAN