Provider Demographics
NPI:1447253117
Name:KINKEL, GLENDA L (FNP)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:L
Last Name:KINKEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PAWNEE AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGLER
Mailing Address - State:CO
Mailing Address - Zip Code:80815-9286
Mailing Address - Country:US
Mailing Address - Phone:719-765-4777
Mailing Address - Fax:719-765-4357
Practice Address - Street 1:305 PAWNEE AVE
Practice Address - Street 2:
Practice Address - City:FLAGLER
Practice Address - State:CO
Practice Address - Zip Code:80815-9286
Practice Address - Country:US
Practice Address - Phone:719-765-4777
Practice Address - Fax:719-765-4357
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7969-4Medicare ID - Type Unspecified
D28405Medicare UPIN