Provider Demographics
NPI:1043647480
Name:KENNEDY, AMIE (PA-C)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 W 26TH AVE STE 420C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5363
Mailing Address - Country:US
Mailing Address - Phone:303-698-0333
Mailing Address - Fax:
Practice Address - Street 1:2460 W 26TH AVE STE 420C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5363
Practice Address - Country:US
Practice Address - Phone:303-698-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.003642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant