Provider Demographics
NPI:1477724672
Name:CUNNINGHAM, KASSANDRA B (PA-C)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:B
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-645-0090
Mailing Address - Fax:303-645-0092
Practice Address - Street 1:10103 RIDGEGATE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5524
Practice Address - Country:US
Practice Address - Phone:303-645-0090
Practice Address - Fax:303-645-0092
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1962363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO275747YPNQOtherMEDICARE
CO57575509Medicaid
CO57575509Medicaid
COP01182767Medicare PIN