Provider Demographics
NPI:1285851626
Name:RICHARDSON, ALYSSA RHODES (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RHODES
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARGARET
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-5816
Mailing Address - Fax:303-293-0625
Practice Address - Street 1:101 ERIE PKWY STE 201C
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-4072
Practice Address - Country:US
Practice Address - Phone:303-415-5816
Practice Address - Fax:303-293-0625
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002283363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75685736Medicaid
COCOA105338Medicare PIN