Provider Demographics
NPI:1700029774
Name:AULT, KRISTA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:AULT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:LYNN
Other - Last Name:HENSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 MERCADO ST STE 160
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7309
Mailing Address - Country:US
Mailing Address - Phone:970-385-9850
Mailing Address - Fax:970-385-9854
Practice Address - Street 1:1 MERCADO ST STE 160
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7309
Practice Address - Country:US
Practice Address - Phone:970-385-9850
Practice Address - Fax:970-385-9854
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine