Provider Demographics
NPI:1912921487
Name:MORGENSTEIN, KELLY (PAC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MORGENSTEIN
Suffix:
Gender:F
Credentials:PAC
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 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-5399
Mailing Address - Fax:303-297-5808
Practice Address - Street 1:4820 RIVERBEND RD STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2618
Practice Address - Country:US
Practice Address - Phone:303-415-5399
Practice Address - Fax:303-297-5808
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3643363AM0700X
COPA.0004936363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical