Provider Demographics
NPI:1063568681
Name:GRAESSER, KRISTEN DONOHUE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:DONOHUE
Last Name:GRAESSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7180 E ORCHARD RD
Mailing Address - Street 2:STE 202
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1726
Mailing Address - Country:US
Mailing Address - Phone:303-771-0107
Mailing Address - Fax:
Practice Address - Street 1:7180 E ORCHARD RD
Practice Address - Street 2:STE 202
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1726
Practice Address - Country:US
Practice Address - Phone:303-771-0107
Practice Address - Fax:303-991-5961
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO456512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64178811Medicaid
COP00957325Medicare PIN
CO64178811Medicaid