Individual
ANTHONY KYLE CARCELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4747 ARAPAHOE AVE, BOULDER, CO 80303
(303) 415-7000
(303) 306-7753
Mailing address
PO BOX 173894, DENVER, CO 80217-3894
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2333
CO
363A00000X
Physician Assistant
Primary
PA.0002333
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84289279
—
CO
01
—
P00399431
RAILROAD MEDICARE
CO
Enumeration date
10/18/2006
Last updated
08/13/2019
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