Provider Demographics
NPI:1225566227
Name:VIERA, KRISTEN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:VIERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:REDSUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6955 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4216
Mailing Address - Country:US
Mailing Address - Phone:805-539-2031
Mailing Address - Fax:805-539-2032
Practice Address - Street 1:6955 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4216
Practice Address - Country:US
Practice Address - Phone:805-539-2031
Practice Address - Fax:805-539-2032
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical