Provider Demographics
NPI:1588640544
Name:RECK, KRISTIN M (PA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:RECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:203 S ROLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1508
Mailing Address - Country:US
Mailing Address - Phone:303-286-4560
Mailing Address - Fax:303-286-4589
Practice Address - Street 1:6075 E PARKWAY DR
Practice Address - Street 2:SUITE 160
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-5400
Practice Address - Country:US
Practice Address - Phone:303-286-8900
Practice Address - Fax:303-286-8260
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO516518Medicare ID - Type Unspecified
DEQ02943Medicare UPIN