Individual
MS. KAITLIN M MOSSBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1925 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(303) 776-1234
(720) 494-3107
Mailing address
1925 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3128
(303) 776-1234
(720) 494-3107
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1864
NE
363A00000X
Physician Assistant
Primary
PA.0004663
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65300050
—
CO
Enumeration date
10/29/2014
Last updated
08/01/2016
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