Provider Demographics
NPI:1124204573
Name:PFEIFFER, KRISTEN LINLEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LINLEY
Last Name:PFEIFFER
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 1:3492 BRETON VALLEY DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9065
Mailing Address - Country:US
Mailing Address - Phone:616-464-5943
Mailing Address - Fax:
Practice Address - Street 1:436 44TH ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49548-4371
Practice Address - Country:US
Practice Address - Phone:616-531-9704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant