Provider Demographics
NPI:1811396096
Name:DENENKAMP, KRISTINA JOAN (PA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JOAN
Last Name:DENENKAMP
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 1:38 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1323
Mailing Address - Country:US
Mailing Address - Phone:631-681-9789
Mailing Address - Fax:
Practice Address - Street 1:38 MANOR DR
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1323
Practice Address - Country:US
Practice Address - Phone:631-681-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017818-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant