MEDICARE: KRISTEN LEIGH HERISTCHI MPH, PAC, CAQ-PSYCH

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	363A00000X	Physician Assistant	PA910207	FL
2	363AM0700X	Medical Physician Assistant	PA910207	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E8856Y	OTHER	FL	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1821072190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LEIGH HERISTCHI MPH, PAC, CAQ-PSYCH

Provider Business Mailing Address
First Line	:	6961 INDIAN CREEK PARK DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3833
Country	:	US
Telephone Number	:	863-397-4259
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 CRYSTAL LAKE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-5979
Country	:	US
Telephone Number	:	863-709-8543
Fax Number	:

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	04/07/2026

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Directions to “ KRISTEN LEIGH HERISTCHI MPH, PAC, CAQ-PSYCH” Practice Location

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