Provider Demographics
NPI:1023099348
Name:KOTTENSTETTE, CHRISTOPHER J (PA-C, CPE)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:KOTTENSTETTE
Suffix:
Gender:M
Credentials:PA-C, CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 LARIMER PKWY
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9021
Mailing Address - Country:US
Mailing Address - Phone:970-342-2220
Mailing Address - Fax:970-342-2221
Practice Address - Street 1:4795 LARIMER PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9021
Practice Address - Country:US
Practice Address - Phone:970-342-2220
Practice Address - Fax:970-342-2221
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2011-0006363AM0700X
CAPA22070363AM0700X
UT7881457-1206363AM0700X
COPA 0001157363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S91624Medicare UPIN