Provider Demographics
NPI:1225176647
Name:WEAD, KYLIE P (PA)
Entity Type:Individual
Prefix:MS
First Name:KYLIE
Middle Name:P
Last Name:WEAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:701 E HAMPDEN AVE STE 515
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3880
Mailing Address - Country:US
Mailing Address - Phone:303-209-2503
Mailing Address - Fax:303-761-0803
Practice Address - Street 1:701 E HAMPDEN AVE STE 515
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3880
Practice Address - Country:US
Practice Address - Phone:303-209-2503
Practice Address - Fax:303-761-0803
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0002156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19913575Medicaid
1225176647OtherNPI NUMBER
CO531902YMCJMedicare PIN