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NPI Code Detail

MEDICARE: KIRSTEN BRACHT

MEDICARE: KIRSTEN BRACHT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant10002138AIN

General Provider Information

NPI Number : 1023565587
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTEN BRACHT
Provider Business Mailing Address
First Line : 608 UNION CHAPEL RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9357
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11109 PARKVIEW PLAZA DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number : 260-482-4440
Fax Number : 260-482-4442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2016
Last Update Date : 06/24/2026

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