Active NPI
Kristie L Shin, PA-C
- Physician Assistant
- Peru, IL
National Provider Identifier
1861644734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 385.002340
- Practice address
- 1650 Midtown Rd
Peru, IL 61354-1274 - Phone
- (815) 223-0203
- NPI assigned
- Oct 22, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 385.002340 | IL | Primary |
Addresses
Primary practice location
1650 Midtown Rd
Peru, IL 61354-1274
Mailing address
600 E 1St St
Spring Valley, IL 61362-1512
Phone (815) 664-5311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2357 | WI | MD | Marriage & Family Therapist |
| 385.002340 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316736000000",
"number": "1861644734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 E 1ST ST",
"city": "SPRING VALLEY",
"state": "IL",
"postal_code": "613621512",
"telephone_number": "815-664-5311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 MIDTOWN RD",
"city": "PERU",
"state": "IL",
"postal_code": "613541274",
"telephone_number": "815-223-0203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "KRISTIE",
"middle_name": "L",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-22",
"last_updated": "2011-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "385.002340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.