1407336738 NPI number — MRS. KESLEY NICOLE SANDERS RDH

Table of content: MRS. KESLEY NICOLE SANDERS RDH (NPI 1407336738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407336738 NPI number — MRS. KESLEY NICOLE SANDERS RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
KESLEY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOW
Provider Other First Name:
KESLEY
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407336738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11250 FLORENCE ST
Provider Second Line Business Mailing Address:
28B
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-990-7393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9351 N. WASHINGTON ST.
Provider Second Line Business Practice Location Address:
KIDFIRST CLINIC
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-990-7393
Provider Business Practice Location Address Fax Number:
720-206-0434
Provider Enumeration Date:
08/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  DH.002025138 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 87634972 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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