Provider Demographics
NPI:1265534192
Name:HERR, KRISTINE L (PA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:HERR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCSB STUDENT HEALTH SERVICES BLDG 588, M/C 7002
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-0001
Mailing Address - Country:US
Mailing Address - Phone:805-893-2251
Mailing Address - Fax:805-893-3861
Practice Address - Street 1:UCSB STUDENT HEALTH SERVICES BLDG 588, M/C 7002
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-1416
Practice Address - Country:US
Practice Address - Phone:805-893-2251
Practice Address - Fax:805-893-3861
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16031363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC59259Medicare UPIN
CAWPA16031BMedicare PIN
CAWPA16031AMedicare PIN