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General NPI Number Information
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NPI Number | 1477552495
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Entity Type | Individual
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Provider Name | KRISTEN BARRETT WIGHT PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 8088 VINEYARD PKWY
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City | KALAMAZOO
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State | MI
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Zip | 49009-3892
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Country | US
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Telephone | 269-286-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 601 JOHN STREET, BOX 42
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City | KALAMAZOO
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State | MI
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Zip | 49007
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Country | US
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Telephone | 269-969-6123
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Fax | 269-969-6122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601004402
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License Number State | MI
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