Healthcare Provider Details

I. General information

NPI: 1124425368
Provider Name (Legal Business Name): KRISTEN E REISS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN E DOWNING

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E PIKES PEAK AVE SUITE 220
COLORADO SPRINGS CO
80903-3648
US

IV. Provider business mailing address

455 E PIKES PEAK AVE SUITE 220
COLORADO SPRINGS CO
80903-3648
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-8080
  • Fax: 719-475-0913
Mailing address:
  • Phone: 719-475-8080
  • Fax: 719-475-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0004168
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0004168
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: