Provider Demographics
NPI:1801209424
Name:LEVESQUE, KRISTIN (DO)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4518
Mailing Address - Country:US
Mailing Address - Phone:703-751-8800
Mailing Address - Fax:
Practice Address - Street 1:1606 PRAIRIE CENTER PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601
Practice Address - Country:US
Practice Address - Phone:303-659-5800
Practice Address - Fax:303-659-5156
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021234207R00000X
CODR0058846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine