Provider Demographics
NPI:1295198265
Name:WIEGERT, KIRSTEN (NP-C; AGNP-BC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:WIEGERT
Suffix:
Gender:F
Credentials:NP-C; AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 COMPASS DR STE 377
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8723
Mailing Address - Country:US
Mailing Address - Phone:970-241-2212
Mailing Address - Fax:970-257-2401
Practice Address - Street 1:2754 COMPASS DR STE 377
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8723
Practice Address - Country:US
Practice Address - Phone:970-241-2212
Practice Address - Fax:970-257-2401
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO192127163W00000X
CO992302363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse