Provider Demographics
NPI:1144470212
Name:KIRCHNER, KRISTINA M (PA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:M
Other - Last Name:PAVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:40 N GRAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1765
Mailing Address - Country:US
Mailing Address - Phone:859-781-4900
Mailing Address - Fax:859-572-3045
Practice Address - Street 1:40 N GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1765
Practice Address - Country:US
Practice Address - Phone:859-781-4900
Practice Address - Fax:859-572-3045
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002911363A00000X
IN10001036A363A00000X
KYPA1160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant