=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073339990
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTA KAUMP DACM, L.AC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2024
-----------------------------------------------------
Last Update Date | 11/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3989 E ARAPAHOE RD STE 120
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-740-2026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10013 ARMADILLO DR
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-9720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-941-4483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | ACU.0002883
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------