Provider Demographics
NPI:1891039665
Name:YANG, KRISTEN ELYSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELYSE
Last Name:YANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTE N
Other - Middle Name:ELYSE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:419-520-2495
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:6905 HOSPITAL DR STE 130
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9600
Practice Address - Country:US
Practice Address - Phone:614-923-0300
Practice Address - Fax:614-923-0400
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060816363A00000X
PAOA004988363A00000X
OH003667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant