Provider Demographics
NPI:1023189503
Name:WARNECKE, KINDRA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:LYNN
Last Name:WARNECKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:MC 3000
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-436-4259
Mailing Address - Fax:303-436-4409
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:MC 3000
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-4259
Practice Address - Fax:303-436-4409
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39553208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32372051Medicaid