Provider Demographics
NPI:1073601050
Name:SPENCE, KATHEY RANEA (PA PHYSICIAN ASSISTA)
Entity Type:Individual
Prefix:MRS
First Name:KATHEY
Middle Name:RANEA
Last Name:SPENCE
Suffix:
Gender:F
Credentials:PA PHYSICIAN ASSISTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 W. 2ND PL, MEDICAL PLAZA 2
Mailing Address - Street 2:SUITE #210
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:87022
Mailing Address - Country:US
Mailing Address - Phone:720-321-8080
Mailing Address - Fax:720-321-8081
Practice Address - Street 1:2555 S DOWNING ST
Practice Address - Street 2:#130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5855
Practice Address - Country:US
Practice Address - Phone:303-777-7112
Practice Address - Fax:303-722-0201
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0001558363A00000X
CO1558363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7115132Medicaid
520928Medicare ID - Type Unspecified
CO7115132Medicaid