Basic Information
Provider Information
NPI: 1659646792
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GINGER
FirstName: KRISTEN
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3020 CHILDRENS WAY
Address2: MC5003
City: SAN DIEGO
State: CA
PostalCode: 921234223
CountryCode: US
TelephoneNumber: 8583096300
FaxNumber:  
Practice Location
Address1: 8110 BIRMINGHAM WAY
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921232758
CountryCode: US
TelephoneNumber: 8589664003
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/21/2012
LastUpdateDate: 05/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XNP95002382CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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