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Kristie L Edmisten

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3200 Northline Ave Ste 200, Greensboro, NC 27408-7602

PECOS Enrollment

This provider is enrolled in PECOS as KRISTIE EDMISTEN.

Based on the most recent information from CMS, provider Kristie L Edmisten is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:21 AM.

Profile Details

Provider ID
1164983607
Provider Type
Individual
Full Name
Edmisten, Kristie L
Credential
PA

Gender
Female
Sole Proprietor
No
Enumeration Date
3/27/2019
Last Updated
3/27/2019

Contact Information

Practice Location

3200 Northline Ave Ste 200, Greensboro, NC 27408-7602

(336) 545-5000

(336) 545-5020

Mailing Location

3200 Northline Ave Ste 200, Greensboro, NC 27408-7602

(336) 545-5000

(336) 545-5020

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 0010-08969 North Carolina

Kristie L Edmisten

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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