Provider Demographics
NPI:1922614494
Name:MAVETY, KRISTA MICHELLE (APN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MICHELLE
Last Name:MAVETY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:MICHELLE
Other - Last Name:HALTEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2685 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1358
Mailing Address - Country:US
Mailing Address - Phone:719-592-9890
Mailing Address - Fax:719-264-7910
Practice Address - Street 1:2685 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1358
Practice Address - Country:US
Practice Address - Phone:719-592-9890
Practice Address - Fax:719-264-7910
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995842-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily