Provider Demographics
NPI:1033463674
Name:RAND, KRISTIN R (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:RAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:R
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3317 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2558
Mailing Address - Country:US
Mailing Address - Phone:814-868-8531
Mailing Address - Fax:814-866-1439
Practice Address - Street 1:3317 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2558
Practice Address - Country:US
Practice Address - Phone:814-868-8531
Practice Address - Fax:814-866-1439
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant