ELLEN KINGDOM (NPI# 1508480542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508480542 |
| Entity Type | Individual |
| Full Name | ELLEN KINGDOM |
| Credential | PA-C |
| Practice Address |
4397 Ronald Reagan Blvd Johnstown CO 80534-6445 |
| Mailing Address |
1115 Mohawk Rd Wilmette IL 60091-1244 |
| Practice Telephone | 9706633200 |
| Mailing Telephone | 8476447376 |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-06-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA.0006279 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4450 Union St Ste 200, Johnstown, CO 805342865 | 9703154018 |
| Street Address |
4397 RONALD REAGAN BLVD |
| City | JOHNSTOWN |
| State | CO |
| Zip Code | 80534-6445 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841823549 | Rocky Mountain State Anesthesia Providers | Anesthesiology | 4397 Ronald Reagan Blvd, Johnstown, CO 80534-6445 | 2020-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790299410 | Bauer Occupational Therapy, LLC | Occupational Therapist | 442 La Costa Ln, Johnstown, CO 80534 | 2017-11-17 |
| 1942698071 | Family Physicians of Greeley, LLP | Family Medicine | 473 Castle Pines Ave, Suite 1, Johnstown, CO 80534 | 2014-12-23 |
| 1376761924 | Steven L Martin | Dentist | 5 N. Parish Ave., Johnstown, CO 80534 | 2007-04-20 |
| 1699896613 | Ashlea Elizabeth Franques | Pediatrics | 4435 Ronald Reagan Blvd, Johnstown, CO 80534 | 2007-04-03 |
| 1720069198 | Kenneth A Pettine | Orthopaedic Surgery | 4795 Larimer Parkway, Johnstown, CO 80534 | 2005-11-10 |
| 1043858251 | Kristen Mcfarland | Physical Therapist | 247 Mountain Avenue, Berthoud, CO 80534 | 2019-12-18 |
| 1841780400 | Colorado Rehabilitation Associates LLC | Physical Medicine & Rehabilitation | 4401 Union St, Johnstown, CO 80534 | 2018-05-18 |
| 1073059523 | Santibanez Aguirre PC | Hospitalist | 4401a Union Street, Johnstown, CO 80534 | 2017-01-09 |
| 1811142524 | 25/34 Plastic Surgery Associates, PC | Specialist | 4450 Union St., Suite 100, Johnstown, CO 80534-0001 | 2008-11-21 |
| 1790794824 | Marc Anthony Masotti | Internal Medicine | 4401a Union St, Johnstown, CO 80534-2800 | 2006-08-07 |
| Find all providers in zip 80534 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508055641 | Kristi Lynn Paetzel | Physician Assistant | 4840 Larimer Pkwy Bldg 1, Johnstown, CO 80534-9012 | 2007-10-15 |
| 1174561419 | James Mendillo | Physician Assistant | 1450 Scalp Ave Ste 106, Johnstown, PA 15904-3340 | 2006-06-02 |
| 1316903487 | Jennifer L Naylor | Physician Assistant | 1425 Scalp Ave Ste 175, Johnstown, PA 15904-3324 | 2006-04-26 |
| 1396716601 | Melissa Jay Leonardis | Physician Assistant | 334 Bloomfield St, Johnstown, PA 15904 | 2006-01-27 |
| 1386629483 | Joan Venerosa | Physician Assistant | 700 S. Perry St., St. Mary's Hospital Fam Hlth Cntr At Johnstown Pediatri, Johnstown, NY 12095 | 2005-12-12 |
| 1891301776 | Karen Richtar | Physician Assistant | 1086 Franklin St, Johnstown, PA 15905-4305 | 2020-09-16 |
| 1225643612 | Calli Morgan Smith | Physician Assistant | 100 Susan Dr, Johnstown, PA 15905-2826 | 2020-09-11 |
| 1215546411 | Jessica Miele | Physician Assistant | 1322 Eisenhower Blvd, Johnstown, PA 15904-3307 | 2020-07-24 |
| 1093355059 | Kristen Thompson | Physician Assistant | 1322 Eisenhower Blvd, Johnstown, PA 15904-3307 | 2020-01-08 |
| 1275176604 | Ileana Panebianco | Physician Assistant | 323 Budfield St, Johnstown, PA 15904-3213 | 2019-10-17 |
| Find all providers in JOHNSTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.