Basic Information
| Provider Information | |||||||||
| NPI: | 1356347785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KESSINGER | ||||||||
| FirstName: | TRINA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52631 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850722631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703957878 | ||||||||
| FaxNumber: | 9703957880 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805505989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703957878 | ||||||||
| FaxNumber: | 9703957880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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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 | 207Q00000X | 38015 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 56573049 | 05 | CO | MEDICAID |