Provider Demographics
NPI:1275833212
Name:BARBATO, KELLY J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:J
Last Name:BARBATO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:YDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3455 LUTHERAN PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6028
Mailing Address - Country:US
Mailing Address - Phone:303-665-2603
Mailing Address - Fax:303-665-2605
Practice Address - Street 1:3455 LUTHERAN PKWY STE 210
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6040
Practice Address - Country:US
Practice Address - Phone:303-403-6580
Practice Address - Fax:303-403-7347
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004616363A00000X
AZ4748363AM0700X
CO0004045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical