Basic Information
| Provider Information | |||||||||
| NPI: | 1780692046 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 SHERIDAN DR | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142214836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168578666 | ||||||||
| FaxNumber: | 7168578994 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 LIMESTONE DR | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166312517 | ||||||||
| FaxNumber: | 7166345650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 03/17/2008 | ||||||||
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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 | 363A00000X | 007459-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 00026555301 | 01 | NY | UNIVERA | OTHER | 02210704 | 05 | NY | MEDICAID | 9512301 | 01 | NY | IHA | OTHER | P00090590 | 01 | NY | RR MEDICARE | OTHER | 000570246006 | 01 | NY | HEALTH NOW | OTHER |