Provider Demographics
NPI:1386949154
Name:KENYON, NICOLE C (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:KENYON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4600 HALE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4020
Mailing Address - Country:US
Mailing Address - Phone:303-320-5566
Mailing Address - Fax:303-320-1453
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4020
Practice Address - Country:US
Practice Address - Phone:303-320-5566
Practice Address - Fax:303-320-1453
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2013-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COPA-3116363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical