Provider Demographics
NPI:1831207398
Name:FIRMIN, KRISTIE L (PA)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:L
Last Name:FIRMIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:LEE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8888 SUMMA AVE
Mailing Address - Street 2:CARDIOLOGY TOWER 3RD FLOOR
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3720
Mailing Address - Country:US
Mailing Address - Phone:225-769-4493
Mailing Address - Fax:225-766-3144
Practice Address - Street 1:8888 SUMMA AVE
Practice Address - Street 2:CARDIOLOGY TOWER 3RD FLOOR
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3720
Practice Address - Country:US
Practice Address - Phone:225-769-4493
Practice Address - Fax:225-766-3144
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10534RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1626015Medicaid
5D250P430Medicare ID - Type Unspecified
P75923Medicare UPIN