Provider Demographics
NPI:1528121811
Name:SCHMITT, KIRSTEN W (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:W
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 MUNSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3084
Mailing Address - Country:US
Mailing Address - Phone:231-929-9090
Mailing Address - Fax:231-929-9092
Practice Address - Street 1:447 MUNSON AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3084
Practice Address - Country:US
Practice Address - Phone:231-929-9090
Practice Address - Fax:231-929-9092
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002762363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N58210003Medicare ID - Type Unspecified