Provider Demographics
NPI:1548776719
Name:WILLMANN, KRISTA MARIE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:WILLMANN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 W RADCLIFFE PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1196
Mailing Address - Country:US
Mailing Address - Phone:859-475-3237
Mailing Address - Fax:
Practice Address - Street 1:10103 RIDGEGATE PKWY STE G21
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5524
Practice Address - Country:US
Practice Address - Phone:303-792-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-23
Last Update Date:2017-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09983579-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1640585OtherCOLORADO STATE BOARD OF NURSING RN LICENSE NUMBER
CO0993579-NPOtherCOLORADO SATE BOARD OF NURSING NURSE PRACTITIONER-APN LICENSE NUMBER
F10170783OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION NUMBER