Healthcare Provider Details

I. General information

NPI: 1760600159
Provider Name (Legal Business Name): KARA DINDA HOMMERDING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LAKE PLAZA DR STE A
COLORADO SPRINGS CO
80906-3555
US

IV. Provider business mailing address

1220 LAKE PLAZA DR STE A
COLORADO SPRINGS CO
80906-3555
US

V. Phone/Fax

Practice location:
  • Phone: 719-531-5400
  • Fax:
Mailing address:
  • Phone: 719-531-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number022993
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0003974
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: