Provider Demographics
NPI:1972191823
Name:MARTIN, KINSEY ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ARCH ST STE 506
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1434
Mailing Address - Country:US
Mailing Address - Phone:330-375-3894
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST STE 506
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1434
Practice Address - Country:US
Practice Address - Phone:330-375-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007576RX207RI0200X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease