Provider Demographics
NPI:1497088603
Name:RASMUSSEN, KRISTEN DANIELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:DANIELLE
Last Name:RASMUSSEN
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 1:811 13TH STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-434-1590
Mailing Address - Fax:706-434-1595
Practice Address - Street 1:811 13TH STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-434-1590
Practice Address - Fax:706-434-1595
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1089725OtherPHYSICIAN ASSISTANT CERTIFICATION
GA005689OtherGEORGIA LICENSE