Healthcare Provider Details

I. General information

NPI: 1174202980
Provider Name (Legal Business Name): KRISTIN PAGE BYRD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN PAGE GAUDREAU PA-C

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 HARRIS ST STE A
EUREKA CA
95503-4866
US

IV. Provider business mailing address

2773 HARRIS ST STE A
EUREKA CA
95503-4866
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-1182
  • Fax:
Mailing address:
  • Phone: 707-442-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1174202980
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: