Provider Demographics
NPI:1841424884
Name:CHISUM, KRISTIN JANELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:JANELLE
Last Name:CHISUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:J
Other - Last Name:SCURLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5925-A TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0435
Mailing Address - Country:US
Mailing Address - Phone:661-638-0603
Mailing Address - Fax:
Practice Address - Street 1:5925-A TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0435
Practice Address - Country:US
Practice Address - Phone:661-638-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant