Provider Demographics
NPI:1275713166
Name:GEBHART, KARINA DIANE (PA)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:DIANE
Last Name:GEBHART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-584-8900
Mailing Address - Fax:303-584-0525
Practice Address - Street 1:850 E HARVARD AVE STE 405
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5077
Practice Address - Country:US
Practice Address - Phone:303-584-8900
Practice Address - Fax:303-584-0525
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2520363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34924329Medicaid
COCOA104847Medicare PIN