Provider Demographics
NPI:1255782264
Name:AUSTIN, KRISTEN ANN
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:MI
Mailing Address - Zip Code:49269-9716
Mailing Address - Country:US
Mailing Address - Phone:517-917-7515
Mailing Address - Fax:
Practice Address - Street 1:8103 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:MI
Practice Address - Zip Code:49269-9716
Practice Address - Country:US
Practice Address - Phone:517-917-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704233458363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner