NPI 1558305946 · Physician Assistant - Certified · Kpic
Carrier listings present but Colorado DORA license appears expired or revoked.
NPPES
LOUISVILLE, 80027
Freshness: Unknown
Network Status
Listed with 2 carriers
DORA License
Expired
Medicare
Enrolled but no billing activity
Care Compare
No Care Compare data
PECOS Enrollment
Medicare enrolled
Active NPI with specialty classification
DORA license expired or revoked
No Medicare billing · No electronic endpoint
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.