Provider Demographics
NPI:1144242579
Name:CONNELLY, DARCY LEE (PA)
Entity Type:Individual
Prefix:MS
First Name:DARCY
Middle Name:LEE
Last Name:CONNELLY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:BROOMFIELD FAMILY PRACTICE
Mailing Address - Street 2:1420 W MIDWAY BLVD
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:303-466-1866
Mailing Address - Fax:303-466-4081
Practice Address - Street 1:BROOMFIELD FAMILY PRACTICE
Practice Address - Street 2:1420 W MIDWAY BLVD
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020
Practice Address - Country:US
Practice Address - Phone:303-466-1866
Practice Address - Fax:303-466-4081
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO01399363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO513278Medicare PIN
COP99988Medicare UPIN