Provider Demographics
NPI:1063049781
Name:LEHR, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LEHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SKYLINE BLVD APT 218
Mailing Address - Street 2:
Mailing Address - City:AVENAL
Mailing Address - State:CA
Mailing Address - Zip Code:93204-1850
Mailing Address - Country:US
Mailing Address - Phone:559-386-4500
Mailing Address - Fax:
Practice Address - Street 1:1000 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-1850
Practice Address - Country:US
Practice Address - Phone:559-386-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58110363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant