NPIMap

Individual provider Active NPI

Kristina Lucille Polley, PA-C

  • Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1700274313
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-05418 Issued in NC
Practice address
2409 Murchison Rd
Fayetteville, NC 28301-3519
Phone
(910) 488-4525
NPI assigned
Jan 5, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-05418 NC Primary

Addresses

Primary practice location

2409 Murchison Rd
Fayetteville, NC 28301-3519

Mailing address

444 SW Center St
PO Box 187
Fasion, NC 28341-2834
Phone (847) 797-0528

Other practice location 1

3205 Randall Pkwy Ste 105
Wilmington, NC 28403-2565
Phone (910) 742-9243

Other names 1

  • Ms. Kristina Lucille Sanders Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170831000025 NC Practitioner - Physician Assistant 4688991177 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifesource of North CarolinaGroup PAC ID 7416132428, 172 clinicians
Lifesource Prime IncGroup PAC ID 7810336385, 52 clinicians

Practice addresses (Care Compare)

3205 Randall Pkwy
Suite 105
Wilmington, NC 28403-2565
Phone (910) 742-9243

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-05418NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Goshen Medical Center Incorporated Current Accepting new patients
Goshen Medical Center Incorporated CurrentSince Aug 21, 2017 Accepting new patients
Goshen Medical Center Incorporated CurrentSince Aug 21, 2017 Accepting new patients
Harvest Medical, PLLC Current Accepting new patients
Lifesource Prime Inc CurrentSince Apr 1, 2025 Accepting new patients
Lifesource of North Carolina Physician Assistant CurrentSince Apr 1, 2025 Accepting new patients

Locations

444 SW Center St
Faison, NC 28341
Phone (910) 267-0421

3613 Cape Center Dr
Fayetteville, NC 28304
Phone (910) 354-1720

3205 Randall Pkwy
Ste 105
Wilmington, NC 28403
Phone (910) 338-2880

Interoperability endpoints

  • Direct secure messaging: kpolley@goshenmedical.cloudcraftdirect.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1700274313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 SW CENTER ST",
            "address_2": "PO BOX 187",
            "city": "FASION",
            "state": "NC",
            "postal_code": "283412834",
            "telephone_number": "847-797-0528",
            "fax_number": "855-748-6239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 MURCHISON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283013519",
            "telephone_number": "910-488-4525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3205 Randall Pkwy Ste 105",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032565",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLLEY",
        "first_name": "KRISTINA",
        "middle_name": "LUCILLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-05",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "SANDERS",
            "middle_name": "LUCILLE",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.