Individual
MR. KENNETH GORDON MEYERS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1605 N UNION BLVD, COLORADO SPRINGS, CO 80909-2828
(719) 635-3764
(719) 635-7593
Mailing address
5935 NORTHWIND DR, COLORADO SPRINGS, CO 80918-4809
(719) 200-7589
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
0996511
CO
363LA2200X
Adult Health Nurse Practitioner
0996511
CO
363LG0600X
Gerontology Nurse Practitioner
0996511
CO
363LP2300X
Primary Care Nurse Practitioner
0996511
CO
Other
Enumeration date
09/15/2021
Last updated
10/08/2024
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