Provider Demographics
NPI:1982983946
Name:KAMENSKI, JEFFREY S
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:KAMENSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:S
Other - Last Name:KAMENSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:5821 TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-5603
Mailing Address - Country:US
Mailing Address - Phone:970-640-5367
Mailing Address - Fax:
Practice Address - Street 1:1907 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5016
Practice Address - Country:US
Practice Address - Phone:970-682-3377
Practice Address - Fax:970-682-3340
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003794363A00000X
FLPA9106076363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127918AMedicaid
FLPA9106076OtherPA LICENSE
COPA.0003794OtherMEDICAL LICENSE
GA003127918AMedicaid