Provider Demographics
NPI:1134165665
Name:MURCHISON, KRISTIN DANIELLE (PA)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:DANIELLE
Last Name:MURCHISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:DANIELLE
Other - Last Name:MURCHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:P.O. BOX 92249
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14692-0249
Mailing Address - Country:US
Mailing Address - Phone:716-834-1193
Mailing Address - Fax:716-348-3925
Practice Address - Street 1:445 TREMONT STREET
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6150
Practice Address - Country:US
Practice Address - Phone:716-690-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP49983363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02822035Medicaid
NYPA1913Medicare PIN
NYPA1910Medicare PIN
NYPA1914Medicare PIN
NY02822035Medicaid
NYPA1915Medicare PIN
NYPA1912Medicare PIN
NYPA1911Medicare PIN