Provider Demographics
NPI:1477270718
Name:KYNE, KERI
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:KYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36489 COUNTY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-8526
Mailing Address - Country:US
Mailing Address - Phone:970-545-1695
Mailing Address - Fax:
Practice Address - Street 1:36489 COUNTY ROAD 31
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-8526
Practice Address - Country:US
Practice Address - Phone:970-545-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant