Provider Demographics
NPI:1538778352
Name:DOGGER, KIERSTEN MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:MICHELLE
Last Name:DOGGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:MICHELLE
Other - Last Name:COATNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2159 DIAMOND AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4312
Mailing Address - Country:US
Mailing Address - Phone:616-610-3403
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-672-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant