Healthcare Provider Details

I. General information

NPI: 1043527757
Provider Name (Legal Business Name): KELLY FLEMING HILSENRATH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY LANE FLEMING PA-C

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 17TH ST STE 400
DENVER CO
80202-3901
US

IV. Provider business mailing address

555 17TH ST STE 400
DENVER CO
80202-3901
US

V. Phone/Fax

Practice location:
  • Phone: 720-577-5251
  • Fax: 303-684-7440
Mailing address:
  • Phone: 720-577-5251
  • Fax: 303-684-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105541
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9105541
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005921
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: