Provider Demographics
NPI:1104275163
Name:O'DELL, KALI ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KALI
Middle Name:ANN
Last Name:O'DELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KALI
Other - Middle Name:ANN
Other - Last Name:NOONEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:BOX 115
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6967
Practice Address - Fax:720-777-7279
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004594363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant