MEDICARE: MRS. AMY BEVERLY KINSEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	00698	CO
2	363A00000X	Physician Assistant	PA9120591	FL

General Provider Information

NPI Number	:	1770505117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY BEVERLY KINSEY PA-C

Provider Business Mailing Address
First Line	:	BROOMFIELD FAMILY PRACTICE
Second Line	:	1420 W. MIDWAY BLVD.
City	:	BROOMFIELD
State	:	CO
Zip	:	80020
Country	:	US
Telephone Number	:	303-466-1866
Fax Number	:	303-466-4081

Provider Business Practice Location Address
First Line	:	BROOMFIELD FAMILY PRACTICE
Second Line	:	1420 W. MIDWAY BLVD.
City	:	BROOMFIELD
State	:	CO
Zip	:	80020
Country	:	US
Telephone Number	:	303-466-1866
Fax Number	:	303-466-4081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	12/10/2025

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