Provider Demographics
NPI:1104832609
Name:HEALY, KRISTINA KAY
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:KAY
Last Name:HEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:KAY
Other - Last Name:HEALY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8190 E 1ST AVE STE 100
Mailing Address - Street 2:LOWRY PEDIATRICS
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7211
Mailing Address - Country:US
Mailing Address - Phone:720-859-8222
Mailing Address - Fax:720-859-9777
Practice Address - Street 1:8190 E 1ST AVE STE 100
Practice Address - Street 2:LOWRY PEDIATRICS
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7211
Practice Address - Country:US
Practice Address - Phone:720-859-8222
Practice Address - Fax:720-859-9777
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO49190208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program