Healthcare Provider Details

I. General information

NPI: 1023529849
Provider Name (Legal Business Name): RACHEL M KISTNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ORCHARD PARK RD SUITE A105
WEST SENECA NY
14224
US

IV. Provider business mailing address

550 ORCHARD PARK RD SUITE A105
WEST SENECA NY
14224
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-6000
  • Fax: 716-677-6006
Mailing address:
  • Phone: 716-677-6000
  • Fax: 716-677-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number021559-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: