Healthcare Provider Details

I. General information

NPI: 1447730130
Provider Name (Legal Business Name): LINDSAY KATHERINE SUMMERILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY KATHERINE CHANDLER

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N OGDEN ST STE 550
DENVER CO
80218-3676
US

IV. Provider business mailing address

1960 N OGDEN ST STE 550
DENVER CO
80218-3676
US

V. Phone/Fax

Practice location:
  • Phone: 303-812-6850
  • Fax: 303-812-6859
Mailing address:
  • Phone: 303-812-6850
  • Fax: 303-812-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060031
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: