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General NPI Number Information
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NPI Number | 1639751506
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Entity Type | Individual
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Provider Name | KELLE A RISSMILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 19964 HILLTOP RD STE A
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City | PARKER
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State | CO
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Zip | 80134-7316
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Country | US
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Telephone | 303-841-2212
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 S ONEIDA ST
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City | DENVER
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State | CO
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Zip | 80224-2522
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Country | US
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Telephone | 303-360-6276
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Fax | 303-789-7222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0006734
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License Number State | CO
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