Provider Demographics
NPI:1770505117
Name:SPERRY, AMY KINSEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KINSEY
Last Name:SPERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:BEVERLY
Other - Last Name:KINSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:BROOMFIELD FAMILY PRACTICE
Mailing Address - Street 2:1420 W. MIDWAY BLVD.
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:303-466-1866
Mailing Address - Fax:303-466-4081
Practice Address - Street 1:BROOMFIELD FAMILY PRACTICE
Practice Address - Street 2:1420 W. MIDWAY BLVD.
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020
Practice Address - Country:US
Practice Address - Phone:303-466-1866
Practice Address - Fax:303-466-4081
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00698363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical