MEDICARE: KRISTEN E REISS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA.0004168	CO
2	363AS0400X	Surgical Physician Assistant	PA.0004168	CO

General Provider Information

NPI Number	:	1124425368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN E REISS PA-C

Provider Business Mailing Address
First Line	:	455 E PIKES PEAK AVE
Second Line	:	SUITE 220
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3648
Country	:	US
Telephone Number	:	719-475-8080
Fax Number	:	719-475-0913

Provider Business Practice Location Address
First Line	:	455 E PIKES PEAK AVE
Second Line	:	SUITE 220
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3648
Country	:	US
Telephone Number	:	719-475-8080
Fax Number	:	719-475-0913

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	09/10/2015

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Directions to “ KRISTEN E REISS PA-C” Practice Location

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