Provider Demographics
NPI:1760262646
Name:OUGH, KIRSTEN VERONICA
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:VERONICA
Last Name:OUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 BAYMEADOWS RD E APT 2234
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3065
Mailing Address - Country:US
Mailing Address - Phone:832-585-9667
Mailing Address - Fax:
Practice Address - Street 1:8283 BAYMEADOWS RD E APT 2234
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3065
Practice Address - Country:US
Practice Address - Phone:832-585-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant