Healthcare Provider Details

I. General information

NPI: 1376852921
Provider Name (Legal Business Name): RYAN A KEMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RYAN A. KEMP PA

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 02/08/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 5100
DENVER CO
80218-1254
US

IV. Provider business mailing address

PO BOX 173862
DENVER CO
80217-3862
US

V. Phone/Fax

Practice location:
  • Phone: 303-228-1240
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4700
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003710
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: