Healthcare Provider Details

I. General information

NPI: 1376743856
Provider Name (Legal Business Name): KATHERINE CHESNEY KENNEDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE STE 200
BOULDER CO
80303-1082
US

IV. Provider business mailing address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-3000
  • Fax:
Mailing address:
  • Phone: 303-440-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0060344
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: