Provider Demographics
NPI:1003104290
Name:BEHARRY, STACY MAXWELL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MAXWELL
Last Name:BEHARRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:799 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2700
Mailing Address - Country:US
Mailing Address - Phone:303-789-2663
Mailing Address - Fax:303-788-4871
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:SUTE 400
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-789-2663
Practice Address - Fax:303-788-4871
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6152363A00000X
COPA0004352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41473868Medicaid
CO41473868Medicaid
CO442399YMCJMedicare PIN