Provider Demographics
NPI:1508055641
Name:PAETZEL, KRISTI LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:PAETZEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LYNN
Other - Last Name:KLOBERDANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4840 LARIMER PKWY BLDG 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9012
Mailing Address - Country:US
Mailing Address - Phone:970-624-2830
Mailing Address - Fax:970-624-2836
Practice Address - Street 1:4840 LARIMER PKWY BLDG 1
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9012
Practice Address - Country:US
Practice Address - Phone:970-624-2830
Practice Address - Fax:970-624-2836
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42422540Medicaid
CO42422540Medicaid
CO569850YLB8OtherMEDICARE
CO42422540Medicaid