Provider Demographics
NPI:1063474682
Name:HARTMAN, KRISTIN ELLEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ELLEN
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 PROVIDENCE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-2986
Mailing Address - Country:US
Mailing Address - Phone:704-544-7535
Mailing Address - Fax:704-544-7570
Practice Address - Street 1:7800 PROVIDENCE RD STE 209
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2986
Practice Address - Country:US
Practice Address - Phone:704-544-7535
Practice Address - Fax:704-544-7570
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q55574Medicare UPIN
2764603Medicare ID - Type Unspecified