Provider Demographics
NPI:1245685510
Name:JAMISON, KRISTIN (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:JAMISON
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:KIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:1455 W CHANDLER BLVD STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6177
Practice Address - Country:US
Practice Address - Phone:480-899-2900
Practice Address - Fax:833-973-4362
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28196781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201355450Medicaid
IN201355450Medicaid
INP01705191OtherRR MEDICARE
IN169380037Medicare PIN