1407336738 NPI number — MRS. KESLEY NICOLE SANDERS RDH

Table of content: JASON W AYERS (NPI 1487216289)

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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