Provider Demographics
NPI:1114999661
Name:MEHAFFIE, VALERIE (PA-C)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MEHAFFIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:SWOMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1800 E 3RD AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5016
Mailing Address - Country:US
Mailing Address - Phone:970-403-0555
Mailing Address - Fax:970-403-0557
Practice Address - Street 1:1800 E 3RD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5016
Practice Address - Country:US
Practice Address - Phone:970-403-0555
Practice Address - Fax:970-403-0557
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002512363AM0700X
MI5601003889363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP89697Medicare UPIN