Provider Demographics
NPI:1124492871
Name:MEYER, KRISTY L (PAC)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:L
Last Name:MEYER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:KRISTY
Other - Middle Name:L
Other - Last Name:BIRKEMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1003 BELLEFONTAINE AVE STE 200
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1803
Practice Address - Country:US
Practice Address - Phone:419-227-7702
Practice Address - Fax:419-227-7991
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004489363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical