Provider Demographics
NPI:1235466673
Name:MEYERS, DEEDRA K (PA - C)
Entity Type:Individual
Prefix:
First Name:DEEDRA
Middle Name:K
Last Name:MEYERS
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 1:8890 N UNION BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7799
Mailing Address - Country:US
Mailing Address - Phone:719-667-0888
Mailing Address - Fax:719-667-0808
Practice Address - Street 1:8890 N UNION BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7799
Practice Address - Country:US
Practice Address - Phone:719-667-0888
Practice Address - Fax:719-667-0808
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105221363A00000X
CO0003623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DK577ZMedicare UPIN