Provider Demographics
NPI:1164762670
Name:LANDES, KIRSTEN ELIZABETH (PA-C, NP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:LANDES
Suffix:
Gender:F
Credentials:PA-C, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 WOODSIDE OAKS APT 4
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4846
Mailing Address - Country:US
Mailing Address - Phone:916-747-0425
Mailing Address - Fax:
Practice Address - Street 1:2020 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-3120
Practice Address - Country:US
Practice Address - Phone:916-341-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22540363A00000X
CAF0713681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant