Provider Demographics
NPI:1942436480
Name:TEJADA, KRISTEN JOY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:JOY
Last Name:TEJADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:JOY
Other - Last Name:VANHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:17 FONTANA LN
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3042
Mailing Address - Country:US
Mailing Address - Phone:410-687-0000
Mailing Address - Fax:410-391-8656
Practice Address - Street 1:17 FONTANA LN
Practice Address - Street 2:SUITE #101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3042
Practice Address - Country:US
Practice Address - Phone:410-687-0000
Practice Address - Fax:410-391-8656
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant