Provider Demographics
NPI:1629520671
Name:AYERS, KENNISHA (PA-C)
Entity Type:Individual
Prefix:
First Name:KENNISHA
Middle Name:
Last Name:AYERS
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 STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-226-4650
Mailing Address - Fax:303-751-6069
Practice Address - Street 1:1444 S POTOMAC ST STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4509
Practice Address - Country:US
Practice Address - Phone:303-226-4650
Practice Address - Fax:303-751-6069
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004835363AS0400X
CO4835363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO551619ZKASMedicare PIN