NPI 1104925635 · Physician Assistant - Certified · Kpic
Strong multi-source corroboration of active practice across 2 carrier networks with confirmed Colorado DORA license.
NPPES
NORTHGLENN, 80234
Freshness: Unknown
Network Status
Listed with 2 carriers
DORA License
Active
Medicare
Not enrolled in Medicare (PECOS)
Care Compare
No Care Compare data
PECOS Enrollment
No PECOS data
Active NPI with specialty classification
Active Colorado DORA license confirmed
No Medicare billing · No electronic endpoint · No PECOS enrollment
Single address source (NPPES)
Limited carrier network presence
2 networks across 1 carrier
Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.