Provider Demographics
NPI:1083654859
Name:PACHECO, KRISTINE SALAZAR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:SALAZAR
Last Name:PACHECO
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8890 N UNION BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7799
Mailing Address - Country:US
Mailing Address - Phone:719-365-9950
Mailing Address - Fax:719-365-9969
Practice Address - Street 1:100 COOK ST STE 306
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5339
Practice Address - Country:US
Practice Address - Phone:720-516-9400
Practice Address - Fax:719-365-6094
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COPA-1850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18689043Medicaid
CO18689043Medicaid