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NPI Code Detail

MEDICARE: KELLY KING PA-C

MEDICARE: KELLY KING 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
1363AS0400XSurgical Physician AssistantPA.0005485CO

General Provider Information

NPI Number : 1922527001
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY KING PA-C
Provider Business Mailing Address
First Line : 1750 E KEN PRATT BLVD
Second Line :
City : LONGMONT
State : CO
Zip : 80504-5311
Country : US
Telephone Number : 720-718-7000
Fax Number : 720-718-0973
Provider Business Practice Location Address
First Line : 1690 MEADE ST
Second Line :
City : DENVER
State : CO
Zip : 80204-1552
Country : US
Telephone Number : 970-391-4303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2017
Last Update Date : 03/06/2026

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Directions to “ KELLY KING PA-C” Practice Location

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