Provider Demographics
NPI:1134556871
Name:KELLY-MCKNIGHT, ELIZABETH ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:KELLY-MCKNIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 S. UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3904
Mailing Address - Country:US
Mailing Address - Phone:303-388-9322
Mailing Address - Fax:303-388-3910
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 480
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3904
Practice Address - Country:US
Practice Address - Phone:303-388-9322
Practice Address - Fax:303-388-3910
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003764363A00000X
COPA0003764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant