Basic Information
| Provider Information | |||||||||
| NPI: | 1609079359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | KIRSTIN | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12006 KILARNEY DR | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224077207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407869771 | ||||||||
| FaxNumber: | 5405488803 | ||||||||
| Practice Location | |||||||||
| Address1: | 1031 CARE WAY | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224018425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403717600 | ||||||||
| FaxNumber: | 5403748949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0110002070 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1609079359 | 05 | VA | MEDICAID |