Healthcare Provider Details

I. General information

NPI: 1457687972
Provider Name (Legal Business Name): KIERSTEN ALISA HANSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIERSTEN ALISA MELENDEZ PA

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 661-326-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: