Healthcare Provider Details

I. General information

NPI: 1356709026
Provider Name (Legal Business Name): KRISTEN E MUNKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BLAKE AVE STE 202
GLENWOOD SPRINGS CO
81601-4261
US

IV. Provider business mailing address

1830 BLAKE AVE STE 202
GLENWOOD SPRINGS CO
81601-4261
US

V. Phone/Fax

Practice location:
  • Phone: 970-384-7510
  • Fax:
Mailing address:
  • Phone: 970-384-7510
  • Fax: 970-384-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA176310
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0005176
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: