Provider Demographics
NPI:1447036173
Name:DEKOSTER, KIRSTEN KELSEY (PA-C)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:KELSEY
Last Name:DEKOSTER
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 1:1880 FALL RIVER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7158
Mailing Address - Country:US
Mailing Address - Phone:970-744-4712
Mailing Address - Fax:970-460-1484
Practice Address - Street 1:1880 FALL RIVER DR STE 210
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7158
Practice Address - Country:US
Practice Address - Phone:970-484-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant