Healthcare Provider Details

I. General information

NPI: 1477667947
Provider Name (Legal Business Name): KRISTEL A. STEVENS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

50 ALCONA AVE
AMHERST NY
14226-2201
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4000
  • Fax:
Mailing address:
  • Phone: 716-834-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: