Provider Demographics
NPI:1093210635
Name:JOHNSON, KRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 DUKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3133
Mailing Address - Country:US
Mailing Address - Phone:720-999-1089
Mailing Address - Fax:
Practice Address - Street 1:2801 PURCELL ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3551
Practice Address - Country:US
Practice Address - Phone:303-659-9700
Practice Address - Fax:303-558-8222
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant