Provider Demographics
NPI:1093145682
Name:KRISTIN BUSCHEMEYER, PA-C, PLLC
Entity Type:Organization
Organization Name:KRISTIN BUSCHEMEYER, PA-C, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCHEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:203-641-5358
Mailing Address - Street 1:418 WINGED FOOT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7741
Mailing Address - Country:US
Mailing Address - Phone:203-641-5358
Mailing Address - Fax:
Practice Address - Street 1:418 WINGED FOOT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7741
Practice Address - Country:US
Practice Address - Phone:203-641-5358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty