Provider Demographics
NPI:1225646409
Name:PIRES, KIRANMAYI PADMAJA (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRANMAYI
Middle Name:PADMAJA
Last Name:PIRES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIRANMAYI
Other - Middle Name:
Other - Last Name:NAVANEETHAKRISHNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:325 S TELLER ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-7388
Mailing Address - Country:US
Mailing Address - Phone:303-403-6600
Mailing Address - Fax:
Practice Address - Street 1:325 S TELLER ST STE 250
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-7429
Practice Address - Country:US
Practice Address - Phone:303-403-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
COPA.0007939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant