Provider Demographics
NPI:1902958911
Name:COLBY, KRISTEEN MARIE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTEEN
Middle Name:MARIE
Last Name:COLBY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MARGARET ST # B
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1468
Mailing Address - Country:US
Mailing Address - Phone:518-891-5696
Mailing Address - Fax:
Practice Address - Street 1:354 BROADWAY
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1146
Practice Address - Country:US
Practice Address - Phone:518-897-1000
Practice Address - Fax:518-897-2128
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant