Healthcare Provider Details

I. General information

NPI: 1750614608
Provider Name (Legal Business Name): KRISTIN LEIGH MIKKELSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 FOXTRAIL DR
LOVELAND CO
80538-9088
US

IV. Provider business mailing address

8075 VILLAGE DR
CINCINNATI OH
45242-4315
US

V. Phone/Fax

Practice location:
  • Phone: 970-500-2244
  • Fax:
Mailing address:
  • Phone: 501-454-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00097471
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number363AM0700X
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number00097471
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC371
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003850A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0698
License Number StateSD
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1448-023
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.003856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: