Healthcare Provider Details

I. General information

NPI: 1023099348
Provider Name (Legal Business Name): CHRISTOPHER J KOTTENSTETTE PA-C, CPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4795 LARIMER PKWY
JOHNSTOWN CO
80534-9021
US

IV. Provider business mailing address

4795 LARIMER PKWY
JOHNSTOWN CO
80534-9021
US

V. Phone/Fax

Practice location:
  • Phone: 970-342-2220
  • Fax: 970-342-2221
Mailing address:
  • Phone: 970-342-2220
  • Fax: 970-342-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2011-0006
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22070
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7881457-1206
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 0001157
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: