Healthcare Provider Details

I. General information

NPI: 1922199975
Provider Name (Legal Business Name): KETTIE D MEYER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19641 E PARKER SQUARE DR SUITE A
PARKER CO
80134-7399
US

IV. Provider business mailing address

19641 E PARKER SQUARE DR SUITE A
PARKER CO
80134-7399
US

V. Phone/Fax

Practice location:
  • Phone: 303-841-2212
  • Fax: 303-841-4716
Mailing address:
  • Phone: 303-841-2212
  • Fax: 303-841-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1982
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: