Healthcare Provider Details

I. General information

NPI: 1124302807
Provider Name (Legal Business Name): KRISTA L ENNS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRIST WINTERRINGER PA-C

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 W 29TH AVE
WHEAT RIDGE CO
80033-8002
US

IV. Provider business mailing address

7495 W 29TH AVE
WHEAT RIDGE CO
80033-8002
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-6276
  • Fax: 303-467-5355
Mailing address:
  • Phone: 303-360-6276
  • Fax: 303-467-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0003305
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: