Provider Demographics
NPI:1093413205
Name:SERRANO, KISHA T (RN, BSN)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:T
Last Name:SERRANO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-4103
Mailing Address - Country:US
Mailing Address - Phone:719-583-4364
Mailing Address - Fax:719-583-4439
Practice Address - Street 1:101 W 9TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4103
Practice Address - Country:US
Practice Address - Phone:719-583-4364
Practice Address - Fax:719-583-4439
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1671525364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public HealthGroup - Multi-Specialty