Provider Demographics
NPI:1780550186
Name:MCCABE, KENZIE TARYN (NP)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:TARYN
Last Name:MCCABE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3884 SANDY VISTA TRL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-3517
Mailing Address - Country:US
Mailing Address - Phone:262-989-6647
Mailing Address - Fax:
Practice Address - Street 1:240 S ELIZABETH ST UNIT 103
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7546
Practice Address - Country:US
Practice Address - Phone:262-989-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1001298-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner