Provider Demographics
NPI:1144651696
Name:HOEME, KARISSA (PA-C)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:HOEME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16830 NORTHGATE DRIVE SUITE 130
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:303-805-7246
Mailing Address - Fax:303-840-7159
Practice Address - Street 1:11960 LIONESS WAY STE 130
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5643
Practice Address - Country:US
Practice Address - Phone:303-750-8100
Practice Address - Fax:303-369-1891
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004569363A00000X
KS1501664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03250067Medicaid