Provider Demographics
NPI:1649605197
Name:SHOCK, KRISTINA MICHELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:SHOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:MICHELLE
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4003 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1337
Mailing Address - Country:US
Mailing Address - Phone:724-309-5095
Mailing Address - Fax:724-765-5475
Practice Address - Street 1:4003 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1337
Practice Address - Country:US
Practice Address - Phone:724-309-5095
Practice Address - Fax:724-765-5475
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056234363A00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine