Healthcare Provider Details

I. General information

NPI: 1245685510
Provider Name (Legal Business Name): KRISTIN JAMISON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN KIRSCH

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 W CHANDLER BLVD STE 4
CHANDLER AZ
85224-6177
US

IV. Provider business mailing address

710 N NILES AVE
SOUTH BEND IN
46617-1924
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-2900
  • Fax: 833-973-4362
Mailing address:
  • Phone: 574-647-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28196781
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: