Provider Demographics
NPI:1598843831
Name:BABB, KRISTIN KAY (PA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:KAY
Last Name:BABB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:KAY
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10238 E HAMPTON AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209
Mailing Address - Country:US
Mailing Address - Phone:480-889-1573
Mailing Address - Fax:480-889-1574
Practice Address - Street 1:10238 E HAMPTON AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-889-1573
Practice Address - Fax:480-889-1574
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3518363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ219332Medicaid
AZ219332Medicaid
AZ113328Medicare PIN