NPI 1780648378 · Physician Assistant - Certified · Kpic
Moderate evidence supports active practice with 2 carrier network listings and verified licensure.
NPPES
BOULDER, 80301
Freshness: Unknown
Network Status
Listed with 2 carriers
DORA License
Active
Medicare
Enrolled but no billing activity
Care Compare
No Care Compare data
PECOS Enrollment
Medicare enrolled
Active NPI with specialty classification
Active Colorado DORA license confirmed
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.