Basic Information
| Provider Information | |||||||||
| NPI: | 1144651696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOEME | ||||||||
| FirstName: | KARISSA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16830 NORTHGATE DRIVE SUITE 130 | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038057246 | ||||||||
| FaxNumber: | 3038407159 | ||||||||
| Practice Location | |||||||||
| Address1: | 11960 LIONESS WAY STE 130 | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037508100 | ||||||||
| FaxNumber: | 3033691891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2013 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA0004569 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 03250067 | 05 | CO | MEDICAID |