Provider Demographics
NPI:1750493763
Name:KIRTLEY, KRISTINE MILLER (PA)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MILLER
Last Name:KIRTLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19701 KINGWOOD DR.
Mailing Address - Street 2:BLDG 10, ST C
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-547-4050
Mailing Address - Fax:832-644-1475
Practice Address - Street 1:19701 KINGWOOD DR.
Practice Address - Street 2:BLDG 10, ST C
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-547-4050
Practice Address - Fax:832-644-1475
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24716Medicare UPIN
TX8654K4Medicare PIN