Provider Demographics
NPI:1174833008
Name:SYLVAN, KRISTIN ASHLEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ASHLEY
Last Name:SYLVAN
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 1:9706 STONE RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-1601
Mailing Address - Country:US
Mailing Address - Phone:214-455-9557
Mailing Address - Fax:
Practice Address - Street 1:9706 STONE RIVER CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1601
Practice Address - Country:US
Practice Address - Phone:214-455-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19352363A00000X
TXPA05712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX299765YKP5Medicare PIN
TX299765YKQLMedicare PIN