Healthcare Provider Details

I. General information

NPI: 1497088603
Provider Name (Legal Business Name): KRISTEN DANIELLE RASMUSSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH STREET SUITE 10
AUGUSTA GA
30901
US

IV. Provider business mailing address

811 13TH STREET SUITE 10
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-434-1590
  • Fax: 706-434-1595
Mailing address:
  • Phone: 706-434-1590
  • Fax: 706-434-1595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005689
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: