Provider Demographics
NPI:1386946051
Name:MCFAGUE, KIERSTEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KIERSTEN
Middle Name:
Last Name:MCFAGUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10800 KNIGHTS RD
Mailing Address - Street 2:2ND FLOOR HEART UNIT
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:267-350-3155
Mailing Address - Fax:215-612-5692
Practice Address - Street 1:10800 KNIGHTS RD
Practice Address - Street 2:2ND FLOOR HEART UNIT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:267-350-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4099363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant