Provider Demographics
NPI:1003846080
Name:TRUMAN, KRISTIE ANN (PA)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:ANN
Last Name:TRUMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4595 JENNIFER LANE
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-772-0453
Mailing Address - Fax:989-773-2538
Practice Address - Street 1:315 E WARWICK DR
Practice Address - Street 2:SUITE F-1
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-463-0957
Practice Address - Fax:989-968-4032
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1352915060OtherBCBSM
MIMI2468001Medicare PIN
MIP00443962Medicare PIN
MIN55280007Medicare PIN