Provider Demographics
NPI:1225080328
Name:TIMOTHY, MELISSA WHERLEY (PA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:WHERLEY
Last Name:TIMOTHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:WHERLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9123 E NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1918
Mailing Address - Country:US
Mailing Address - Phone:720-985-8949
Mailing Address - Fax:
Practice Address - Street 1:1360 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4505
Practice Address - Country:US
Practice Address - Phone:303-337-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPA000062363AM0700X
CO1598363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO027088OtherKAISER COMMERCIAL NUMBER
CO40724336Medicaid
GUP67742Medicare UPIN
CO40724336Medicaid
CO479394YK5YMedicare PIN