Individual
KIRSTEN JEAN MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6801 W 20TH ST, SUITE 101, GREELEY, CO 80634-9637
(970) 378-8000
(970) 378-8088
Mailing address
6801 W 20TH ST, SUITE 101, GREELEY, CO 80634-9637
(970) 378-8000
(970) 378-8088
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3883
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.0003883
CO STATE BOARD
CO
Enumeration date
12/23/2013
Last updated
01/21/2015
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