Provider Demographics
NPI:1063834331
Name:PLUMMER, KARISSA BARTHOLME (PA-C)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:BARTHOLME
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:MARIE
Other - Last Name:BARTHOLME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:619-278-3300
Mailing Address - Fax:619-278-3310
Practice Address - Street 1:501 WASHINGTON ST STE 600
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2239
Practice Address - Country:US
Practice Address - Phone:619-278-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA51246363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant