Provider Demographics
NPI:1164258703
Name:PAZDERNIK, KRISTIN MARIE (PMHNP-BC, MSN, RN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:PAZDERNIK
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5647 PALMIA LN
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-6183
Mailing Address - Country:US
Mailing Address - Phone:714-402-0604
Mailing Address - Fax:
Practice Address - Street 1:11027 S PIKES PEAK DR
Practice Address - Street 2:#202
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138
Practice Address - Country:US
Practice Address - Phone:720-432-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000073363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health