Provider Demographics
NPI:1326089202
Name:JOHNSON, KRISTINE ARRIETA (PA)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ARRIETA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:L
Other - Last Name:ARRIETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1760 E RIVER ROAD
Mailing Address - Street 2:350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718
Mailing Address - Country:US
Mailing Address - Phone:520-519-7720
Mailing Address - Fax:520-519-5181
Practice Address - Street 1:2625 N CRAYCROFT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2254
Practice Address - Country:US
Practice Address - Phone:520-324-2409
Practice Address - Fax:520-324-2454
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ133599Medicaid
Q27511Medicare UPIN
AZZ131493Medicare PIN