Provider Demographics
NPI:1588650857
Name:ELDRED, KIRSTEN LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LYNN
Last Name:ELDRED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:LYNN
Other - Last Name:ELDRED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 ALEXIS DR
Mailing Address - Street 2:SUSQUEHANNA CARDIOLOGY ASSOCIATES, P. C.
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-9720
Mailing Address - Country:US
Mailing Address - Phone:570-321-2800
Mailing Address - Fax:570-321-6490
Practice Address - Street 1:130 ALEXIS DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-9720
Practice Address - Country:US
Practice Address - Phone:570-321-2800
Practice Address - Fax:570-321-6490
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051227363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP85512Medicare UPIN
PA068576Medicare ID - Type Unspecified