Provider Demographics
NPI:1932481736
Name:BAUER, KRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:AHMIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2155 E CONFERENCE DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2604
Mailing Address - Country:US
Mailing Address - Phone:480-831-2445
Mailing Address - Fax:480-897-1283
Practice Address - Street 1:2155 E CONFERENCE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2604
Practice Address - Country:US
Practice Address - Phone:480-831-2445
Practice Address - Fax:480-897-1283
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4986363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical