Provider Demographics
NPI:1639187966
Name:KARSTEN, JONATHAN CARL (PA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CARL
Last Name:KARSTEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80001-0467
Mailing Address - Country:US
Mailing Address - Phone:303-422-7991
Mailing Address - Fax:303-422-7994
Practice Address - Street 1:8451 PEARL STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:303-422-7991
Practice Address - Fax:303-422-7994
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2006363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46201335Medicaid
CO803934Medicare ID - Type Unspecified
CO46201335Medicaid