Provider Demographics
NPI:1760886147
Name:PARIS, KIRSTEN L (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:L
Last Name:PARIS
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 1:201 SIGMA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7715
Mailing Address - Country:US
Mailing Address - Phone:843-302-8840
Mailing Address - Fax:
Practice Address - Street 1:2550 ELMS CENTER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9844
Practice Address - Country:US
Practice Address - Phone:843-302-8840
Practice Address - Fax:843-818-2188
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2087PAMedicaid
SC2087PAMedicaid