Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ellen Kingdom, PA-C

Individual provider Physician Assistant · NPI 1508480542

Ellen Kingdom, PA-C is a Physician Assistant in Cheyenne, Wyoming. Qualified in 2020, 6 years ago. Practices with Cheyenne Urological P C, a 6-clinician group and accepts Medicare assignment. Licensed in Colorado and Wyoming.

Years since qualifying
6
Licensed in
CO, WY
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2301 House Ave Ste 502
Cheyenne, WY 82001-3179
Phone: (307) 635-4131
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PT909 (WY)
Physician Assistant Taxonomy 363A00000X · Licence PA.0006279 (CO)

Record details

NPI number1508480542
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 5, 2020
Last updated in NPPESDecember 4, 2020
Certification dateOctober 13, 2020
Mailing address2301 House Ave Ste 502, Cheyenne, WY 82001-3179

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Cheyenne Urological P C — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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