Provider Demographics
NPI:1710005475
Name:MAGUIRE, KATHLEEN R (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:MAGUIRE
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 1:2627 REDWING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6310
Mailing Address - Country:US
Mailing Address - Phone:970-631-8650
Mailing Address - Fax:970-672-8137
Practice Address - Street 1:2627 REDWING RD STE 300
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6310
Practice Address - Country:US
Practice Address - Phone:970-631-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO830363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC502548Medicare ID - Type UnspecifiedMEDICARE