Provider Demographics
NPI:1356970917
Name:FRASER, KIRSTEN (PA-C)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:FRASER
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 1:261 CAROL JEAN WAY
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3303
Mailing Address - Country:US
Mailing Address - Phone:908-566-6481
Mailing Address - Fax:
Practice Address - Street 1:1255 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3398
Practice Address - Country:US
Practice Address - Phone:973-685-5755
Practice Address - Fax:862-662-2342
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062277363AM0700X
390200000X
NJ25MP00827600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program