Provider Demographics
NPI:1780855833
Name:DAVIS, KRISTIN RICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RICHELLE
Last Name:DAVIS
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 1:716 ADAIR AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2836
Mailing Address - Country:US
Mailing Address - Phone:740-454-5239
Mailing Address - Fax:740-455-7693
Practice Address - Street 1:716 ADAIR AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2836
Practice Address - Country:US
Practice Address - Phone:740-454-5239
Practice Address - Fax:740-455-7693
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2790609OtherMCAID, MORGAN - FFS
36-1926OtherMEDICARE GROUP - MUSKINGUM
1205018348OtherMORGAN NPI - FFS
1841472982OtherMUSK NPI - FQHC
1528257789OtherMORGAN NPI - FQHC
1104008242OtherMUSK NPI - FFS
36-1923OtherMORGAN MEDICARE GROUP
2790547OtherMCAID, MUSK - FQHC
2790583OtherMCAID,MORGAN - FQHC
2790574OtherMCAID, MUSK - FFS
1205018348OtherMORGAN NPI - FFS