Kristen Amanda Ettlin, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2021001164 Issued in MO

Practice address

Harry S. Truman Memorial Veterans Hospital
800 Hospital Drive
Columbia, MO 65201

Phone

(573) 814-6565

Fax

(573) 814-6176

NPI assigned

Feb 29, 2020

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 names 1

• Ms. Kristen Amanda Fisher Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1582934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1548894454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4140 HIGHWAY 54",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652513848",
            "telephone_number": "573-544-7907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HARRY S. TRUMAN MEMORIAL VETERANS HOSPITAL",
            "address_2": "800 HOSPITAL DRIVE",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "65201",
            "telephone_number": "573-814-6565",
            "fax_number": "573-814-6176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTLIN",
        "first_name": "KRISTEN",
        "middle_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-29",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2021001164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "FISHER",
            "middle_name": "AMANDA",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jasmine Espinoza, MAT, LAT, ATC
• Stephanie Bianca Espinoza, MD
• Kelsey Esser Templeton, LCSW
• Jackie Esser, LPC
• Holly B Estrem, LPC
• Catherine Eubank
• Anna-Grace Eubanks
• Megan Joy Eudaly, P.A.
• Adrienne Leigh Evans, PA-C
• Allison Danielle Evans, PHARM.D.

• Physician Assistant in Columbia, MO
• Providers in Columbia, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.