Provider Demographics
NPI:1083899876
Name:KINZIE, KAY (NP)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:
Last Name:KINZIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:EAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-777-6006
Practice Address - Fax:720-777-7294
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001933363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05-150OtherAPN RX AUTHORITY
CO68028OtherNURSING LICENSE