Provider Demographics
NPI:1710492590
Name:GREEAR, KRISTIE K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:K
Last Name:GREEAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20200 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2634
Mailing Address - Country:US
Mailing Address - Phone:313-914-4590
Mailing Address - Fax:
Practice Address - Street 1:20200 OUTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2634
Practice Address - Country:US
Practice Address - Phone:313-914-4590
Practice Address - Fax:313-914-4531
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical