Healthcare Provider Details

I. General information

NPI: 1144324500
Provider Name (Legal Business Name): KAREN L WILDER P-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 5050
DENVER CO
80218-1200
US

IV. Provider business mailing address

1601 E 19TH AVE SUITE 4300
DENVER CO
80218-1216
US

V. Phone/Fax

Practice location:
  • Phone: 720-754-2155
  • Fax: 720-754-2106
Mailing address:
  • Phone: 303-861-4845
  • Fax: 303-861-4842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3290
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: