Provider Demographics
NPI:1215139753
Name:MEYER, KRISTEN A (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:MEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1740 E PARIS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6204
Mailing Address - Country:US
Mailing Address - Phone:616-949-5600
Mailing Address - Fax:616-949-6571
Practice Address - Street 1:1740 E PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6204
Practice Address - Country:US
Practice Address - Phone:616-949-5600
Practice Address - Fax:616-949-6571
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004982OtherSTATE LICENSE