Provider Demographics
NPI:1396779096
Name:KIRKPATRICK, KYLE (PA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5788
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5788
Mailing Address - Country:US
Mailing Address - Phone:303-202-1280
Mailing Address - Fax:303-202-1281
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:ST. ANTHONY HOSPITAL, EMERGENCY DEPT.
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:720-321-4161
Practice Address - Fax:720-321-4165
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04370363AM0700X
CO2229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83707522Medicaid
TX8N8386OtherBCBS
TXQ41183Medicare UPIN
COC806558Medicare PIN
TX8N8386OtherBCBS