Provider Demographics
NPI:1801068705
Name:WILFLEY, KATHERINE FIFER (PA-C, MMSC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:FIFER
Last Name:WILFLEY
Suffix:
Gender:F
Credentials:PA-C, MMSC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JENNIFER
Other - Last Name:FIFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C, MMSC
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-436-6000
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO3282363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00936660OtherMEDICARE RAILROAD
OR383860OtherMEDICARE RHC
OR500605562Medicaid
OR383860OtherMEDICARE RHC