Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APN-0997094-NP | CO |
NPI | 1003574005 |
---|---|
Provider Name | Alyssa Kersch |
First Address | Peyton, CO 80831-7090 |
Second Address | Peyton, CO 80831-7090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2021 |
Last Update Date | 07/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AG10210147 | ADULT-GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER (01) | |
APN-0997094-NP | NURSE PRACTITIONER - APN (01) | CO |
RXN-0106201-NP | NURSE PRACTITIONER - RNX (01) | CO |