Provider Demographics
NPI:1124837851
Name:CALDERON, KRISTEN GRACE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:GRACE
Last Name:CALDERON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 FARNAM ST APT 2519
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3516
Mailing Address - Country:US
Mailing Address - Phone:972-979-8954
Mailing Address - Fax:
Practice Address - Street 1:3105 N 93RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4717
Practice Address - Country:US
Practice Address - Phone:877-859-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical