Provider Demographics
NPI:1588746424
Name:LIVINGSTON, KRISTEN LEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LEE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 BLACKBURN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PARIS
Mailing Address - State:PA
Mailing Address - Zip Code:15554
Mailing Address - Country:US
Mailing Address - Phone:814-839-4711
Mailing Address - Fax:
Practice Address - Street 1:110 FRANKLIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1829
Practice Address - Country:US
Practice Address - Phone:814-535-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002837L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant