Healthcare Provider Details

I. General information

NPI: 1518607233
Provider Name (Legal Business Name): KIRA GRESSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 COUNTY ROAD 14
DEL NORTE CO
81132-8758
US

IV. Provider business mailing address

12631 E 17TH AVE
AURORA CO
80045-2527
US

V. Phone/Fax

Practice location:
  • Phone: 719-657-2510
  • Fax:
Mailing address:
  • Phone: 303-724-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDR.0077794
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberDR.0077794
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0077794
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: