Basic Information
| Provider Information | |||||||||
| NPI: | 1578938817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEARLS | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | CARROLL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MMS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11154 HURON ST | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | NORTHGLENN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802342328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039205161 | ||||||||
| FaxNumber: | 3034524625 | ||||||||
| Practice Location | |||||||||
| Address1: | 11154 HURON ST | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | NORTHGLENN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802342328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039205161 | ||||||||
| FaxNumber: | 3034524625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2015 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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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 | PA.0004497 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.