Healthcare Provider Details

I. General information

NPI: 1821596552
Provider Name (Legal Business Name): KRISTIN E PLYER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E MUIRWOOD DR STE 111
PHOENIX AZ
85048-7693
US

IV. Provider business mailing address

4530 E MUIRWOOD DR STE 111
PHOENIX AZ
85048-7693
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-2365
  • Fax: 480-961-2382
Mailing address:
  • Phone: 480-961-2365
  • Fax: 480-961-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: