Individual provider Active NPI

Kristina Reavis, APN

  • Acute Care Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1992327217
Registry record updated May 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
995088 Issued in CO
Practice address
400 W 16TH St
Pueblo, CO 81003-2781
Phone
(719) 659-8141
NPI assigned
May 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 995088 CO
Acute Care Nurse Practitioner 363LA2100X 995088 CO Primary

Addresses

Primary practice location

400 W 16TH St
Pueblo, CO 81003-2781

Mailing address

312 Michigan Ave
Manitou Springs, CO 80829-1637
Phone (719) 659-8141

Other identifiers 1

IdentifierTypeStateIssuer
0OtherN/A

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Pueblo

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20220223001124 CO Practitioner - Nurse Practitioner 0547654261 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

  • Parkview Medical Center, Inc Hospital, Pueblo, CO, CCN 060020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
995088COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince May 29, 2025 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince May 29, 2025 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

58 Club Manor Dr
Pueblo, CO 81008
Phone (719) 584-4045

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

1600 N Grand Ave
Ste 430
Pueblo, CO 81003
Phone (719) 545-8240

Organizations & group practices 2

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

Hospital & facility affiliations 7

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": "1588896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588896000000",
    "number": "1992327217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 MICHIGAN AVE",
            "city": "MANITOU SPRINGS",
            "state": "CO",
            "postal_code": "808291637",
            "telephone_number": "719-659-8141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032781",
            "telephone_number": "719-659-8141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAVIS",
        "first_name": "KRISTINA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-08",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "995088",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CO",
            "license": "995088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Pueblo",
            "affiliation": "N",
            "address_1": "400 W 16th St",
            "city": "Pueblo",
            "state": "CO",
            "country_code": "US",
            "postal_code": "810032781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.