Provider Demographics
NPI:1477115764
Name:KOUANCHAO, KALI ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:ELIZABETH
Last Name:KOUANCHAO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 LUTHERAN PKWY STE 340
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6039
Mailing Address - Country:US
Mailing Address - Phone:303-996-6005
Mailing Address - Fax:303-420-8831
Practice Address - Street 1:3555 LUTHERAN PKWY STE 340
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6039
Practice Address - Country:US
Practice Address - Phone:303-996-6005
Practice Address - Fax:303-420-8831
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0994669NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics