Individual
MRS. KRISTIN M TAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSHS, PA-C
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
(260) 482-5060
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 482-5060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002037A
IN
363AS0400X
Surgical Physician Assistant
PA030564
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300006007
—
IN
Enumeration date
10/28/2008
Last updated
01/15/2019
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