Healthcare Provider Details

I. General information

NPI: 1386896520
Provider Name (Legal Business Name): KATHERINE ANN KINNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE ANN CASSEL

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W BAPTIST RD STE 100
COLORADO SPRINGS CO
80921-2480
US

IV. Provider business mailing address

12810 MORRIS TRL
COLORADO SPRINGS CO
80908-3231
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-9852
  • Fax: 719-426-9796
Mailing address:
  • Phone: 719-424-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002042
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0006524
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: