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NPI Code Detail

MEDICARE: KRISTIN HAUCK PA-C

MEDICARE: KRISTIN HAUCK PA-C
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 Assistant10000759AIN

General Provider Information

NPI Number : 1083821441
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN HAUCK PA-C
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5693 YMCA PARK DR W
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3280
Country : US
Telephone Number : 260-469-6603
Fax Number : 260-486-6123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 10/20/2022

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Directions to “ KRISTIN HAUCK PA-C” Practice Location

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