Healthcare Provider Details

I. General information

NPI: 1356653968
Provider Name (Legal Business Name): KRISTEN BIERI KOCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MEREDITH BIERI PA-C

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 DILLON DR
SPARTANBURG SC
29307-1018
US

IV. Provider business mailing address

304 FAULKNER DR
MOORE SC
29369-8823
US

V. Phone/Fax

Practice location:
  • Phone: 864-327-1212
  • Fax:
Mailing address:
  • Phone: 864-706-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1479
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: