Provider Demographics
NPI:1275515629
Name:KENNEDY, YANA (APN)
Entity Type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:YANA
Other - Middle Name:
Other - Last Name:SCHMALZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:4891 INDEPENDENCE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6713
Mailing Address - Country:US
Mailing Address - Phone:303-456-5495
Mailing Address - Fax:303-456-7490
Practice Address - Street 1:8410 DECATUR ST STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3811
Practice Address - Country:US
Practice Address - Phone:303-430-7000
Practice Address - Fax:303-430-1506
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004618-CNS363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39185036Medicaid
CO39185036Medicaid
CO802138Medicare ID - Type Unspecified