Provider Demographics
NPI:1003885633
Name:HANSEN, KRISTI JO (PA)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:JO
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:JO
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9256 W NORMA TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4814
Mailing Address - Country:US
Mailing Address - Phone:605-274-0546
Mailing Address - Fax:
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0669363A00000X
IA000894363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
274726Medicare ID - Type Unspecified
S11937Medicare UPIN