Provider Demographics
NPI:1952688780
Name:MANGIONE, KRISTEN L (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:MANGIONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:BJORKLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11083 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5873
Mailing Address - Country:US
Mailing Address - Phone:303-833-8880
Mailing Address - Fax:
Practice Address - Street 1:11083 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-5873
Practice Address - Country:US
Practice Address - Phone:303-833-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68650582Medicaid
COCOAAA4227Medicare PIN