Provider Demographics
NPI:1235264508
Name:OLY, CATHY ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ANN
Last Name:OLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15425 DESIREE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3515
Mailing Address - Country:US
Mailing Address - Phone:719-510-7902
Mailing Address - Fax:719-526-8883
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:BLDG 7489- WARRRIOR RECOVERY CENTER
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-526-4911
Practice Address - Fax:719-526-8883
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70487065Medicaid
COCO300660Medicare PIN
P53359Medicare UPIN