Provider Demographics
NPI:1376852921
Name:KEMP, RYAN A
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:KEMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:A
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1601 E 19TH AVE STE 5100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1254
Practice Address - Country:US
Practice Address - Phone:303-228-1240
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4700363A00000X
COPA.0003710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01268756OtherRAILROAD MEDICARE
CO30427576Medicaid
CO296393YL2GMedicare PIN
CO547006ZLF7Medicare PIN