Provider Demographics
NPI:1518322767
Name:WERNER, KIRSTEN (PA)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:WERNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6690 CROSSINGS DR SE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7394
Mailing Address - Country:US
Mailing Address - Phone:616-600-1881
Mailing Address - Fax:616-600-2782
Practice Address - Street 1:6690 CROSSINGS DR SE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-600-1885
Practice Address - Fax:616-600-2782
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant