Provider Demographics
NPI:1265497630
Name:DUGGINS, KIRSTEN C (PA, NP)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:C
Last Name:DUGGINS
Suffix:
Gender:F
Credentials:PA, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BROOKE ACRES DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-6462
Mailing Address - Country:US
Mailing Address - Phone:408-656-9049
Mailing Address - Fax:
Practice Address - Street 1:221 BROOKE ACRES DR
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-6462
Practice Address - Country:US
Practice Address - Phone:408-656-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12256363A00000X
CAPA 12256363AS0400X
CA257522-4568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS921ZMedicare UPIN