Provider Demographics
NPI:1477141307
Name:OLIPHANT, KIRSTIN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MARIE
Last Name:OLIPHANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 JUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:DOUBLE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3031
Mailing Address - Country:US
Mailing Address - Phone:972-966-1980
Mailing Address - Fax:
Practice Address - Street 1:8501 JUSTIN RD
Practice Address - Street 2:
Practice Address - City:DOUBLE OAK
Practice Address - State:TX
Practice Address - Zip Code:75077-3031
Practice Address - Country:US
Practice Address - Phone:972-966-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14089363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant