Provider Demographics
NPI:1245304252
Name:KILPATRICK, LISA CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINE
Last Name:KILPATRICK
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 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:303-862-7102
Practice Address - Street 1:340 E 1ST AVE STE 102
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2454
Practice Address - Country:US
Practice Address - Phone:720-798-0170
Practice Address - Fax:303-862-7102
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2006 0041363AM0700X
CO3140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74428578Medicaid
NM343702603Medicare PIN
NMQ74342Medicare UPIN