Provider Demographics
NPI:1003582347
Name:KAZZI, KRISTIN ELIE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELIE
Last Name:KAZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:ELIE
Other - Last Name:KAZZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:54 WILMOT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2646
Mailing Address - Country:US
Mailing Address - Phone:978-382-3544
Mailing Address - Fax:
Practice Address - Street 1:630 TURNPIKE ST. STE 1
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6000
Practice Address - Country:US
Practice Address - Phone:978-208-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant