Provider Demographics
NPI:1871093336
Name:KINNEY, LISA (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3035 S PARKER RD STE 562
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2901
Mailing Address - Country:US
Mailing Address - Phone:303-671-6110
Mailing Address - Fax:303-369-7673
Practice Address - Street 1:3035 S PARKER RD STE 562
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2901
Practice Address - Country:US
Practice Address - Phone:303-671-6110
Practice Address - Fax:303-369-7673
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0005071207QH0002X
COPA.0005071363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine