Provider Demographics
NPI:1952411647
Name:MAGGI, KRISTINE RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:RENEE
Last Name:MAGGI
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 1:760 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6445
Mailing Address - Country:US
Mailing Address - Phone:307-871-9300
Mailing Address - Fax:855-733-2371
Practice Address - Street 1:2091 BOX BUTTE AVE STE 700
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-4458
Practice Address - Country:US
Practice Address - Phone:308-762-7244
Practice Address - Fax:308-761-1249
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY290207RG0100X
NE2412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311835OtherBLUE CROSS
970029372OtherRAILROAD MEDICARE
WY311835OtherBLUE CROSS
970029372OtherRAILROAD MEDICARE