Healthcare Provider Details

I. General information

NPI: 1104360668
Provider Name (Legal Business Name): LINDSAY N KOTAL PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 05/21/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 ALOHA ST STE 100
CASTLE ROCK CO
80108-2388
US

IV. Provider business mailing address

1151 ALOHA ST STE 100
CASTLE ROCK CO
80108
US

V. Phone/Fax

Practice location:
  • Phone: 720-330-1305
  • Fax: 720-452-2079
Mailing address:
  • Phone: 720-330-1305
  • Fax: 720-452-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.4789
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: