Provider Demographics
NPI:1932467016
Name:KAZMEROFF, CHRISTY A (PMHNP, FNP, ACNP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:A
Last Name:KAZMEROFF
Suffix:
Gender:F
Credentials:PMHNP, FNP, ACNP
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:A
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19641 E PARKER SQUARE DR STE J
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7397
Mailing Address - Country:US
Mailing Address - Phone:720-766-8321
Mailing Address - Fax:720-358-5924
Practice Address - Street 1:19641 E PARKER SQUARE DR STE J
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7397
Practice Address - Country:US
Practice Address - Phone:720-766-8321
Practice Address - Fax:720-358-5924
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-990343363LA2100X, 363LF0000X
CORN-167801163W00000X
CO990343363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000155669Medicaid