Provider Demographics
NPI:1053462895
Name:KENNEY, ERIKA S (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:S
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W. 38TH AVE.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2107
Mailing Address - Country:US
Mailing Address - Phone:303-420-1297
Mailing Address - Fax:303-420-2953
Practice Address - Street 1:4500 W. 38TH AVE.
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2107
Practice Address - Country:US
Practice Address - Phone:303-420-1297
Practice Address - Fax:303-420-2953
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO38298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93985240Medicaid
COH38209Medicare UPIN
CO93985240Medicaid