Provider Demographics
NPI:1720637176
Name:GUTHRIE, KRISTIN CAROLYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CAROLYNN
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:CAROLYNN
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:W150S7048 CORNELL CIR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-8987
Mailing Address - Country:US
Mailing Address - Phone:440-371-7624
Mailing Address - Fax:
Practice Address - Street 1:W150S7048 CORNELL CIR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-8987
Practice Address - Country:US
Practice Address - Phone:440-371-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5737-23363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant