Provider Demographics
NPI:1144635327
Name:KITCHENS, DIANE (AA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KITCHENS
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 E MAPLEWOOD AVE
Mailing Address - Street 2:BLDG 5, SUITE 200
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-785-4700
Mailing Address - Fax:
Practice Address - Street 1:8000 E MAPLEWOOD AVE
Practice Address - Street 2:BLDG 5, STE 200
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-785-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAA2014-004367H00000X
COANT.0000068367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1144635327Medicaid