Provider Demographics
NPI:1871596940
Name:SIEMON, KRISTIN B (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:B
Last Name:SIEMON
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 1:575 COAL VALLEY RD STE 464
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3740
Mailing Address - Country:US
Mailing Address - Phone:412-267-6360
Mailing Address - Fax:
Practice Address - Street 1:575 COAL VALLEY RD STE 464
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3740
Practice Address - Country:US
Practice Address - Phone:412-267-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
11938577OtherCAQH
PA1007485980005Medicaid
PA1007485980002Medicaid
PA508429Medicare ID - Type UnspecifiedGROUP
PA0584900002Medicare NSC
PA1007485980002Medicaid
PA0584900001Medicare NSC
PA0584900003Medicare NSC
PA1007485980005Medicaid