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Individual

AUTUMN K ONKST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
7852 S ELATI ST SUITE 101, LITTLETON, CO 80120-8079
(303) 703-9151
(303) 703-9150
Mailing address
11356 MESA VERDE WAY, PARKER, CO 80138-3015
(859) 396-6162

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA790
KY
363AS0400X
Surgical Physician Assistant
Primary
PA790
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000377925
ANTHEM
KY
01
030670000
BLACK LUNG
KY
01
50005325
PASSPORT HEALTH PLAN
KY
01
61-1427889
CHA
KY
05
95005088
KY
01
C60877
CUMBERLAND HEALTHCARE INC
KY
Enumeration date
01/29/2007
Last updated
08/12/2011
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