Provider Demographics
NPI:1568452779
Name:LEE, KENYA DENAY (MD)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:DENAY
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:DENAY
Other - Last Name:BEVERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2601
Mailing Address - Country:US
Mailing Address - Phone:719-597-8707
Mailing Address - Fax:719-597-6864
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2601
Practice Address - Country:US
Practice Address - Phone:719-597-8707
Practice Address - Fax:719-597-6864
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46715208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO306728Medicaid
I54815Medicare UPIN