Provider Demographics
NPI:1932947272
Name:KISLING, DAKOTA SAGE (PA-C)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:SAGE
Last Name:KISLING
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 1:252 EVERETT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1447
Mailing Address - Country:US
Mailing Address - Phone:303-524-2486
Mailing Address - Fax:
Practice Address - Street 1:252 EVERETT AVE APT 1
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1447
Practice Address - Country:US
Practice Address - Phone:303-524-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64681363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical