Provider Demographics
NPI:1356800924
Name:TYMKEW, KIRSTIN LAMPI (PA-C)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:LAMPI
Last Name:TYMKEW
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 1:3790 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-8332
Mailing Address - Country:US
Mailing Address - Phone:269-979-6310
Mailing Address - Fax:
Practice Address - Street 1:3790 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-8332
Practice Address - Country:US
Practice Address - Phone:269-979-6310
Practice Address - Fax:269-979-8807
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant