Individual provider Active NPI

Kristin Leigh Mikkelsen, PA-C

  • Medical Physician Assistant
  • Loveland, CO
National Provider Identifier
1750614608
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
00097471 Issued in CO
Practice address
1625 Foxtrail Dr
Loveland, CO 80538-9088
Phone
(970) 500-2244
NPI assigned
Sep 10, 2009
Last updated
Feb 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 00097471 CO
Physician Assistant 363A00000X 363AM0700X OH
Physician Assistant 363A00000X 1448-023 WI
Physician Assistant 363A00000X TC371 KY
Physician Assistant 363A00000X
Physician Assistant 363A00000X 10003850A IN
Medical Physician Assistant 363AM0700X 00097471 CO Primary
Medical Physician Assistant 363AM0700X 0698 SD
Medical Physician Assistant 363AM0700X 50.003856 OH

Addresses

Primary practice location

1625 Foxtrail Dr
Loveland, CO 80538-9088

Mailing address

1625 Foxtrail Dr Ste 190
Loveland, CO 80538-9089

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, IN, KY, CO4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20140218001932 OH Practitioner - Physician Assistant 7416121074 Reassigns benefits to 2 organizations
I20230315000606 IN Practitioner - Physician Assistant 7416121074 Reassigns benefits to 1 organization
I20230503000611 KY Practitioner - Physician Assistant 7416121074 Reassigns benefits to 1 organization
I20251218004550 CO Practitioner - Physician Assistant 7416121074 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

525 W Brown Rd
Mesa, AZ 85201-3202

8075 Village Dr
Cincinnati, OH 45242-4315

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
TC371KYMDPhysician Assistant
363AM0700XOHMDPhysician Assistant
1448-023WIMDPhysician Assistant
00097471COMDMedical Physician Assistant
50.003856OHMDMedical Physician Assistant
0698SDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
S&S Primary Care LLC CurrentSince Jan 5, 2025 Accepting new patients
Banner Fort Collins PCP LLC CurrentSince Jan 15, 2026 Accepting new patients
CHMC Community Health Services Network Past Accepting new patients
Extended Care Specialists, Inc PastSince Oct 6, 2024 Accepting new patients

Locations

3519 Richmond Dr
Fort Collins, CO 80526
Phone (970) 204-0300

205 S Main St
Ste B
Longmont, CO 80501
Phone (303) 772-6244

1625 Foxtrail Dr
Ste 190
Loveland, CO 80538
Phone (970) 500-2244

11294 Montgomery Rd
Cincinnati, OH 45249
Phone (513) 815-7000

Interoperability endpoints

  • Direct secure messaging: kmikkelsen143420@direct.bsmhealth.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771459200000",
    "number": "1750614608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 FOXTRAIL DR STE 190",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 FOXTRAIL DR",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389088",
            "telephone_number": "970-500-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKKELSEN",
        "first_name": "KRISTIN",
        "middle_name": "LEIGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-10",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "00097471",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "363AM0700X",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1448-023",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC371",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10003850A",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "00097471",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SD",
            "license": "0698",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50.003856",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.