Provider Demographics
NPI:1275085888
Name:REINICHE, KRISTEN J (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:J
Last Name:REINICHE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:J
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-7782
Mailing Address - Fax:
Practice Address - Street 1:2817 ROCK MERRITT AVENUE
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-2682
Practice Address - Country:US
Practice Address - Phone:910-907-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-30
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00472900363A00000X
IL085.006070363A00000X
NC0010-11345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant