Provider Demographics
NPI:1861666489
Name:PROCHNIO, KIRK WERNER (PA-C)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:WERNER
Last Name:PROCHNIO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 YOUNGFIELD ST
Mailing Address - Street 2:STE 150
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2263
Mailing Address - Country:US
Mailing Address - Phone:303-238-4277
Mailing Address - Fax:303-238-4977
Practice Address - Street 1:2801 YOUNGFIELD ST
Practice Address - Street 2:STE 150
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2263
Practice Address - Country:US
Practice Address - Phone:303-238-4277
Practice Address - Fax:303-238-4977
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA-2474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA-2474OtherCOLORADO LICENSURE