KRYSTAL MARIE LI (NPI# 1598387904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598387904 |
| Entity Type | Individual |
| Full Name | KRYSTAL MARIE LI |
| Credential | PA-C |
| Practice Address |
7333 W Jefferson Blvd Fort Wayne IN 46804-6280 |
| Mailing Address |
1333 Windover Ct Fort Wayne IN 46845-9754 |
| Practice Telephone | 2604583858 |
| Mailing Telephone | 2604379408 |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2020-05-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
7333 W JEFFERSON BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-6280 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699778753 | Deborah S Castile | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2005-05-23 |
| 1487264818 | Holly Bowman | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2020-07-31 |
| 1245850106 | Kimberly A. Burns | Nurse Practitioner | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2020-04-21 |
| 1497375356 | Stacey M. Krick | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2020-04-21 |
| 1619519915 | Liece Laurens | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2019-10-08 |
| 1689226797 | Crista Randol | Nurse Practitioner | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2019-07-10 |
| 1780156299 | Jenna Marie Waterman | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6202 | 2018-12-21 |
| 1063982973 | Hannah Victoria Duggan | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2018-12-04 |
| 1548746837 | Jodi Grover | Nurse Practitioner | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2018-07-19 |
| 1366951428 | Amber Apple | Registered Nurse | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2017-09-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104438944 | Erin R Griffin | Physician Assistant | 5621 Woodshire Dr Apt 5, Fort Wayne, IN 46835-2959 | 2020-08-22 |
| 1821608209 | Rebecca Coker | Physician Assistant | 5137 Truemper Way Apt 5, Fort Wayne, IN 46835-3252 | 2020-07-31 |
| 1114536844 | Amanda Kohl | Physician Assistant | 5429 River Run Trl # 5, Fort Wayne, IN 46825-6039 | 2020-07-29 |
| 1538778352 | Kiersten Michelle Coatney | Physician Assistant | 3924 Taylor Rd Apt 65, Fort Wayne, IN 46804-1945 | 2020-07-28 |
| 1013366905 | Brianna Abbott | Physician Assistant | 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 | 2016-06-10 |
| 1972890093 | Megan Bearman | Physician Assistant | 3640 New Vision Dr, Suite A, Fort Wayne, IN 46845-1717 | 2011-07-10 |
| 1114211729 | Joel A Ruetz | Physician Assistant | 7619 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2011-06-01 |
| 1568617256 | Parkview Health System Inc | Physician Assistant | 11104 Parkview Circle Dr Ste 320, Fort Wayne, IN 46845-1733 | 2008-11-21 |
| 1841441805 | Brooke B Kutka | Physician Assistant | 2512 East Dupont Rd, Suite 200, Fort Wayne, IN 46825-1609 | 2008-10-08 |
| 1265688808 | Kali E Veness | Physician Assistant | 2930 Lake Ave, Fort Wayne, IN 46805-5416 | 2008-08-14 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.