Provider Demographics
NPI:1811910243
Name:EVERSOLE, KRISTEN SUSSANNE (PA)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:SUSSANNE
Last Name:EVERSOLE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:4045 BYRDS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4149
Mailing Address - Country:US
Mailing Address - Phone:813-727-9465
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:1324 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4543
Practice Address - Country:US
Practice Address - Phone:863-687-1132
Practice Address - Fax:863-687-1439
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-02-19
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant