MEDICARE: KRISTIN MYERS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	002320	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326271412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MYERS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-7048
Country	:	US
Telephone Number	:	203-284-2800
Fax Number	:	203-294-8734

Provider Business Practice Location Address
First Line	:	896 WASHINGTON ST
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-2912
Country	:	US
Telephone Number	:	860-788-3632
Fax Number	:	860-788-2085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	07/14/2020

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