Active NPI
Kirk Kritner, PAC
- Physician Assistant
- Alamosa, CO
National Provider Identifier
1407846405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 866
- Practice address
- 106 Blanca Ave
Alamosa, CO 81101-2340 - Phone
- (719) 589-8053
- Fax
- (719) 587-1372
- NPI assigned
- Oct 21, 2005
- Last updated
- May 1, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 866 | CO | Primary |
Addresses
Primary practice location
106 Blanca Ave
Alamosa, CO 81101-2340
Mailing address
106 Blanca Ave
Alamosa, CO 81101-2340
Phone (719) 589-2511
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| COW52119 | Other | CO | ANTHEM BC/BS |
| 20178875 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 866 | CO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335830400000",
"number": "1407846405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 BLANCA AVE",
"city": "ALAMOSA",
"state": "CO",
"postal_code": "811012340",
"telephone_number": "719-589-2511",
"fax_number": "719-587-1372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 BLANCA AVE",
"city": "ALAMOSA",
"state": "CO",
"postal_code": "811012340",
"telephone_number": "719-589-8053",
"fax_number": "719-587-1372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRITNER",
"first_name": "KIRK",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-21",
"last_updated": "2012-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "866",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "COW52119",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20178875",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alamosa, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.