Provider Demographics
NPI:1487075347
Name:O'HARA, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 DEERFOOT CIR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2440
Mailing Address - Country:US
Mailing Address - Phone:508-801-3260
Mailing Address - Fax:
Practice Address - Street 1:489 BEARSES WAY
Practice Address - Street 2:UNIT A-4
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2707
Practice Address - Country:US
Practice Address - Phone:508-771-4092
Practice Address - Fax:508-771-9466
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1439363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA5292OtherSTATE LICENSE
MEPA1439OtherSTATE OF MAINE
MAPA5292OtherSTATE LICENSE