NPI 1770547663 · Physician Assistant - Certified · Kpic
Carrier listings present but Colorado DORA license appears expired or revoked.
NPPES
DENVER, 80220
Freshness: Unknown
Network Status
Listed with 2 carriers
DORA License
Inactive
Medicare
Enrolled but no billing activity
Care Compare
No Care Compare data
PECOS Enrollment
Medicare enrolled
Order/Referring eligible: Yes
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.