Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 00000 | CO |
NPI | 1275635773 |
---|---|
Provider Name | Ms. Kristy Joelle States |
First Address | Denver, CO 80224-2161 |
Second Address | Denver, CO 80222-3311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2006 |
Last Update Date | 08/07/2007 |