Provider Demographics
NPI:1710566930
Name:PICKARD, KASEY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:KASEY
Middle Name:LAWRENCE
Last Name:PICKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 LINCOLN ST UNIT 1122
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3860
Mailing Address - Country:US
Mailing Address - Phone:720-314-0782
Mailing Address - Fax:
Practice Address - Street 1:10101 RIDGEGATE PKWY
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5522
Practice Address - Country:US
Practice Address - Phone:720-225-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty