MEDICARE: KATHRYN L REANEY

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	363AS0400X	Surgical Physician Assistant	1489	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982600813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN L REANEY

Provider Business Mailing Address
First Line	:	PO BOX 176201
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80217-6201
Country	:	US
Telephone Number	:	303-534-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 GOLDEN RIDGE RD STE 250
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-9541
Country	:	US
Telephone Number	:	303-233-1223
Fax Number	:

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/22/2021

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Directions to “ KATHRYN L REANEY ” Practice Location

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