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NPI Code Detail

MEDICARE: KRISTIN JANE HOUSE PA

MEDICARE: KRISTIN JANE HOUSE PA
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
1363A00000XPhysician Assistant6253GA

General Provider Information

NPI Number : 1518235217
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN JANE HOUSE PA
Provider Business Mailing Address
First Line : PO BOX 1705
Second Line :
City : AUGUSTA
State : GA
Zip : 30903-1705
Country : US
Telephone Number : 706-774-7263
Fax Number : 706-774-7230
Provider Business Practice Location Address
First Line : 4446 WASHINGTON RD
Second Line : STE # 7
City : EVANS
State : GA
Zip : 30809-6360
Country : US
Telephone Number : 706-774-7263
Fax Number : 706-774-7230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2011
Last Update Date : 10/11/2016

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Directions to “ KRISTIN JANE HOUSE PA” Practice Location

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