Healthcare Provider Details

I. General information

NPI: 1871093336
Provider Name (Legal Business Name): LISA KINNEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 S PARKER RD STE 562
AURORA CO
80014-2901
US

IV. Provider business mailing address

3035 S PARKER RD STE 562
AURORA CO
80014-2901
US

V. Phone/Fax

Practice location:
  • Phone: 303-671-6110
  • Fax: 303-369-7673
Mailing address:
  • Phone: 303-671-6110
  • Fax: 303-369-7673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberPA0005071
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0005071
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: