Kristen L Mace-Wease, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA053430 Issued in PA

Practice address

1700 S Lincoln Ave
Lebanon, PA 17042-7529

Phone

(717) 272-6621

Fax

(717) 228-6045

NPI assigned

Jun 12, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Kristen L Mace Former name

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1043470115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 S LINCOLN AVE",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427529",
            "telephone_number": "717-272-6621",
            "fax_number": "717-228-6045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 S LINCOLN AVE",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427529",
            "telephone_number": "717-272-6621",
            "fax_number": "717-228-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACE-WEASE",
        "first_name": "KRISTEN",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-12",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA053430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MA053430",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "MACE",
            "middle_name": "L",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sara Lutz
• Kayla Elizabeth Lynch, LPC, NCC
• Mackenzie Renee Lynch
• Arthur C. Lyon, MPT
• Danielle Elaine Macas-Senn, DO
• Rachel Maclatchie, BS
• Duncan S. Maclean, MD
• Sivaramaiah Maddukuri, M.D
• Madhukar R Patel
• Honey Queen Magbago

• Medical Physician Assistant in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.