Provider Demographics
NPI:1437118569
Name:BRISTOW, KRISTINE MARKLEY (FNP, MSN, RN, CS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARKLEY
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:FNP, MSN, RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4323
Mailing Address - Country:US
Mailing Address - Phone:719-268-7199
Mailing Address - Fax:
Practice Address - Street 1:8890 N UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2701
Practice Address - Country:US
Practice Address - Phone:719-365-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK658363LF0000X
CO120453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49684256Medicaid
CO49684256Medicaid