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Contact Information

KEN K KRISTOFFERSON, PA
7420 REMCON CIRCLE
BLDG. A
EL PASO, TX79912
 Phone: 915-532-8823
 Fax: 915-532-5909
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KEN K KRISTOFFERSON · (Male)

NPI # 1154341584
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 07/20/2006
Last updated 06/17/2014 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • TX License # PA02936
  • NM Medicaid 76300323
  • TX Medicaid 192820202
  • TX Medicaid 192820203
  • TX Other PA02936 PA LICENSE
Hospital affiliation(s)
  • LAS PALMAS MEDICAL CENTER - (Acute Care)
    1801 NORTH OREGON STREET
    EL PASO, TX 79902
  • PROVIDENCE MEMORIAL HOSPITAL - (Acute Care)
    2001 N OREGON ST
    EL PASO, TX 79902
  • SIERRA MEDICAL CENTER - (Acute Care)
    1625 MEDICAL CENTER DR
    EL PASO, TX 79902
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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