Provider Demographics
NPI:1114178837
Name:SHIPWAY, KIRSTEN LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LYNN
Last Name:SHIPWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1871 W ORANGE GROVE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1289
Mailing Address - Country:US
Mailing Address - Phone:520-382-3050
Mailing Address - Fax:520-382-3055
Practice Address - Street 1:1871 W ORANGE GROVE RD STE 135
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1289
Practice Address - Country:US
Practice Address - Phone:520-382-3050
Practice Address - Fax:520-382-3055
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4286363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical