Provider Demographics
NPI:1457908014
Name:FAIRCHILD, KRISTEN (MMS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MMS
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:FAIRCHILD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MMS
Mailing Address - Street 1:4235 SECOR RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4299
Mailing Address - Country:US
Mailing Address - Phone:419-479-5560
Mailing Address - Fax:419-473-2065
Practice Address - Street 1:4235 SECOR RD BLDG 2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4231
Practice Address - Country:US
Practice Address - Phone:194-795-5604
Practice Address - Fax:419-473-2065
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006035RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical