Provider Demographics
NPI:1043528789
Name:GENSON, KRISTEN RODA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RODA
Last Name:GENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:DENISE
Other - Last Name:RODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9949 S OSWEGO ST
Mailing Address - Street 2:STE 200
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3753
Mailing Address - Country:US
Mailing Address - Phone:303-925-4750
Mailing Address - Fax:303-925-4751
Practice Address - Street 1:9949 S OSWEGO ST
Practice Address - Street 2:STE 200
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3753
Practice Address - Country:US
Practice Address - Phone:303-925-4750
Practice Address - Fax:303-925-4751
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant