Individual
DR. KRISTA DEANN PELLICORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
506 E WESTERN AVE STE 104, AVONDALE, AZ 85323-2422
(602) 230-7373
(602) 230-3086
Mailing address
3101 N CENTRAL AVE STE 550, PHOENIX, AZ 85012-2635
(602) 230-7373
(602) 682-7455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01057388A
IN
207Q00000X
Family Medicine Physician
Primary
48328
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000305690
BCBS PROVIDER NUMBER
—
05
—
200447730
—
IN
05
—
857797
—
AZ
Enumeration date
06/18/2006
Last updated
04/22/2025
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