Provider Demographics
NPI:1245586320
Name:NIEMER, CHRISTINA C (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:C
Last Name:NIEMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ALEXANDRIA PIKE STE 320
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-3243
Mailing Address - Country:US
Mailing Address - Phone:859-781-1310
Mailing Address - Fax:859-572-3021
Practice Address - Street 1:525 ALEXANDRIA PIKE STE 320
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071-3243
Practice Address - Country:US
Practice Address - Phone:859-781-1310
Practice Address - Fax:859-572-3021
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100229450Medicaid
KY7100229450Medicaid