Provider Demographics
NPI:1194705681
Name:HUG, KRISTEN M (PA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:HUG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 S SHOOP AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1735
Mailing Address - Country:US
Mailing Address - Phone:419-335-2663
Mailing Address - Fax:419-335-6916
Practice Address - Street 1:735 S SHOOP AVE
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1735
Practice Address - Country:US
Practice Address - Phone:419-335-2663
Practice Address - Fax:419-335-6916
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000389885OtherANTHEM
OHHUPA25761Medicare PIN
OHPA25762Medicare PIN
OH000000389885OtherANTHEM