Provider Demographics
NPI:1043527757
Name:HILSENRATH, KELLY FLEMING (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:FLEMING
Last Name:HILSENRATH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LANE
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:555 17TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3901
Mailing Address - Country:US
Mailing Address - Phone:720-577-5251
Mailing Address - Fax:303-684-7440
Practice Address - Street 1:555 17TH ST STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-3901
Practice Address - Country:US
Practice Address - Phone:720-577-5251
Practice Address - Fax:303-684-7440
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105541363A00000X
FLPA 9105541363AM0700X
COPA.0005921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002742900Medicaid