Provider Demographics
NPI:1922578970
Name:KISTLER, EMILY MITCHELL (PA-C, MMS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MITCHELL
Last Name:KISTLER
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:NINA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5958 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4221
Mailing Address - Country:US
Mailing Address - Phone:303-214-1055
Mailing Address - Fax:
Practice Address - Street 1:5958 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4221
Practice Address - Country:US
Practice Address - Phone:303-214-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007558363AS0400X, 363A00000X, 363AS0400X
CO7558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical