Provider Demographics
NPI:1942639075
Name:MCKAIG, KAAREN NICOLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAAREN
Middle Name:NICOLE
Last Name:MCKAIG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KAAREN
Other - Middle Name:NICOLE
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-5199
Mailing Address - Fax:303-415-5198
Practice Address - Street 1:6685 GUNPARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3388
Practice Address - Country:US
Practice Address - Phone:303-415-5199
Practice Address - Fax:303-415-5198
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN 0990987-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51777771Medicaid
CO51777771Medicaid
CO331308YNT4Medicare PIN