Healthcare Provider Details

I. General information

NPI: 1225347602
Provider Name (Legal Business Name): AMY KEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY SHOOPMAN

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 RIDGEGATE PKWY
LONE TREE CO
80124-5522
US

IV. Provider business mailing address

PO BOX 173862
DENVER CO
80217-3862
US

V. Phone/Fax

Practice location:
  • Phone: 720-225-1900
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4720
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003709
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: