Provider Demographics
NPI:1053388488
Name:ASHBARRY, KRISTIN M (PA -C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:ASHBARRY
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:SAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:995 SENATOR KEATING BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2776
Mailing Address - Country:US
Mailing Address - Phone:585-279-3600
Mailing Address - Fax:585-473-9299
Practice Address - Street 1:995 SENATOR KEATING BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2776
Practice Address - Country:US
Practice Address - Phone:585-279-3600
Practice Address - Fax:585-473-9299
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6092363AM0700X
NY006092363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02107353Medicaid
NYJ400037369Medicare PIN
J400005364Medicare PIN
NY02107353Medicaid