Basic Information
Provider Information
NPI: 1497164321
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAREY
FirstName: MEREDITH
MiddleName: CELIA
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10350 E DAKOTA AVE
Address2:  
City: DENVER
State: CO
PostalCode: 802471314
CountryCode: US
TelephoneNumber: 3033384545
FaxNumber:  
Practice Location
Address1: 1375 E 19TH AVE
Address2:  
City: DENVER
State: CO
PostalCode: 80218
CountryCode: US
TelephoneNumber: 3033384545
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2014
LastUpdateDate: 06/01/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA031079DCN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X3993COY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


Home