Provider Demographics
NPI:1699123059
Name:LOCKE, KENDRA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:JANE
Last Name:LOCKE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:JANE
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4105 BRIARGATE PKWY STE 125
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3482
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD467115207Q00000X
CODR.0065720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029201OtherKASIER COMMERCIAL NUMBER
CO9000195727Medicaid