Provider Demographics
NPI:1609820786
Name:KARKULA, KRISTY JO
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:JO
Last Name:KARKULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:JO
Other - Last Name:MATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4128
Mailing Address - Fax:970-490-4156
Practice Address - Street 1:1600 MID VALLEY DR UNIT A
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-9006
Practice Address - Country:US
Practice Address - Phone:970-871-9770
Practice Address - Fax:970-871-9771
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2817363AM0700X
COPA.0002817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50652273Medicaid
COP00835976OtherRAILROAD MEDICARE
COCO305250Medicare PIN