Provider Demographics
NPI:1346864527
Name:BRODERICK, KRISTINA P (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:P
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10421 E COUNTY ROAD 100 N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1243
Mailing Address - Country:US
Mailing Address - Phone:317-272-7013
Mailing Address - Fax:317-272-7007
Practice Address - Street 1:10421 E COUNTY ROAD 100 N
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1243
Practice Address - Country:US
Practice Address - Phone:317-272-7013
Practice Address - Fax:317-272-7007
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-09-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant