Provider Demographics
NPI:1124425368
Name:REISS, KRISTEN E (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:REISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:E
Other - Last Name:DOWNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 E PIKES PEAK AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3648
Mailing Address - Country:US
Mailing Address - Phone:719-475-8080
Mailing Address - Fax:719-475-0913
Practice Address - Street 1:455 E PIKES PEAK AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3648
Practice Address - Country:US
Practice Address - Phone:719-475-8080
Practice Address - Fax:719-475-0913
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004168363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical