Provider Demographics
NPI:1154791838
Name:KRISELL, JULIANNA KWAK (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JULIANNA
Middle Name:KWAK
Last Name:KRISELL
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 1:9110 E NICHOLS AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3450
Mailing Address - Country:US
Mailing Address - Phone:720-666-4739
Mailing Address - Fax:
Practice Address - Street 1:300 20TH AVE N STE 406
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2137
Practice Address - Country:US
Practice Address - Phone:720-666-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61030232363A00000X
TN5605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant