Kristofferson Medical, PLLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02936 Issued in TX

Legal business name

KRISTOFFERSON MEDICAL, PLLC

Practice address

3280 Joe Battle Blvd
El Paso, TX 79938-2622

Phone

(915) 474-1798

NPI assigned

May 3, 2012

Organization subpart

No

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

Authorized official

Name

Ken Kristofferson, P.A.

Title

Owner/President

Phone

9159154741798

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336003200000",
    "number": "1760741219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 GATEWAY BLVD W",
            "address_2": "SUITE 120",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799253331",
            "telephone_number": "915-779-1716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 JOE BATTLE BLVD",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799382622",
            "telephone_number": "915-474-1798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISTOFFERSON MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-03",
        "last_updated": "2012-05-03",
        "status": "A",
        "authorized_official_last_name": "KRISTOFFERSON",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "9159154741798",
        "authorized_official_credential": "P.A."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas T Krejchi
• Alexander Kresta, MD
• Stephanie Kretzschmar, PMHNP
• Priscilla Janneth Krinkey, OD
• Guruprasad Krishnamurthy, M.D
• Ken Kim Kristofferson, PA
• Rana Nabil Kronfol
• Vicki L Krueger, B.S. PHARM
• Lillie M Krug, RBT
• Tracy Lynn Krugh

• Physician Assistant in El Paso, TX
• Providers in El Paso, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.

Verify at the official NPI Registry.