1487196564 NPI number — KRISTIN GARST AUD

Table of content: KRISTIN GARST AUD (NPI 1487196564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487196564 NPI number — KRISTIN GARST AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARST
Provider First Name:
KRISTIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487196564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13952 DENVER WEST PKWY
Provider Second Line Business Mailing Address:
STE 325
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-974-9757
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2643 PATTERSON RD
Provider Second Line Business Practice Location Address:
SUITE 503
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81506-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-245-2400
Provider Business Practice Location Address Fax Number:
970-242-9092
Provider Enumeration Date:
11/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AUD.0000828 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AUD.0000828 . This is a "COLORADO LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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