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General NPI Number Information
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NPI Number | 1982791968
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Entity Type | Individual
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Provider Name | KRISTEN HAINEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 4909 W DIVISION ST STE 508
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City | CHICAGO
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State | IL
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Zip | 60651
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Country | US
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Telephone | 773-364-4600
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Fax | 773-854-7511
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Provider Business Mailing Address
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Address Line | 1133 191ST ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-4432
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Country | US
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Telephone | 630-220-3473
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Fax |
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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 | 085002435
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085002435
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License Number State | IL
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