Provider Demographics
NPI:1568650968
Name:BUSCHEMEYER, KRISTIN AMANDA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:AMANDA
Last Name:BUSCHEMEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:A
Other - Last Name:MAARTMANN-MOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:418 WINGED FOOT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7741
Mailing Address - Country:US
Mailing Address - Phone:203-641-5358
Mailing Address - Fax:
Practice Address - Street 1:418 WINGED FOOT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7741
Practice Address - Country:US
Practice Address - Phone:203-641-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08078363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical