Basic Information
| Provider Information | |||||||||
| NPI: | 1629614557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENPRO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5279 SHADE TREE LN | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813463480 | ||||||||
| FaxNumber: | 2814624106 | ||||||||
| Practice Location | |||||||||
| Address1: | 5279 SHADE TREE LN | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813463480 | ||||||||
| FaxNumber: | 2814624106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2019 | ||||||||
| LastUpdateDate: | 11/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2813466480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.