Provider Demographics
NPI:1326088733
Name:PEARSON, KELLY J (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8550 W 38TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WHEATRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-425-2797
Mailing Address - Fax:303-467-9510
Practice Address - Street 1:8550 W 38TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4300
Practice Address - Country:US
Practice Address - Phone:303-467-8987
Practice Address - Fax:303-467-9510
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2057363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00458106OtherMEDICARE RAILROAD
COAB01549OtherANTHEM
COP00458106OtherMEDICARE RAILROAD