Individual
AMANDA GRACE KIESSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2577 MAIN AVE, DURANGO, CO 81301-5919
(970) 247-8382
(970) 259-4403
Mailing address
2577 MAIN AVE, DURANGO, CO 81301-5919
(970) 247-8382
(970) 259-4403
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
6501
AZ
363A00000X
Physician Assistant
Primary
PA.0005179
CO
363A00000X
Physician Assistant
PA2017-0102
NM
Other
Enumeration date
09/02/2016
Last updated
02/23/2022
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