MEDICARE: KRISTINA DENNISE MORDECAI

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0998186-NP	CO
2	163W00000X	Registered Nurse	128167	CO

General Provider Information

NPI Number	:	1376791442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA DENNISE MORDECAI

Provider Business Mailing Address
First Line	:	4155 E JEWELL AVE STE 600
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4510
Country	:	US
Telephone Number	:	303-783-4734
Fax Number	:

Provider Business Practice Location Address
First Line	:	4155 E JEWELL AVE STE 600
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4510
Country	:	US
Telephone Number	:	720-310-2773
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	12/12/2022

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