Provider Demographics
NPI:1568899045
Name:PICHLER, KRISTEN JUSTICE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JUSTICE
Last Name:PICHLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:LAUREN
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1020 E 2ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2955
Mailing Address - Country:US
Mailing Address - Phone:307-233-0250
Mailing Address - Fax:307-263-1485
Practice Address - Street 1:1020 E 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2955
Practice Address - Country:US
Practice Address - Phone:307-233-0250
Practice Address - Fax:814-455-3001
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant