Provider Demographics
NPI:1609079359
Name:GARCIA, KIRSTIN LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:LYNN
Last Name:GARCIA
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 1:12006 KILARNEY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7207
Mailing Address - Country:US
Mailing Address - Phone:540-786-9771
Mailing Address - Fax:540-548-8803
Practice Address - Street 1:1031 CARE WAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8425
Practice Address - Country:US
Practice Address - Phone:540-371-7600
Practice Address - Fax:540-374-8949
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002070363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1609079359Medicaid
015351A79Medicare PIN