Provider Demographics
NPI:1376526533
Name:PATRICK, AMY N (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:PATRICK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1625 FOXTRAIL DR STE 190
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9089
Mailing Address - Country:US
Mailing Address - Phone:970-619-6900
Mailing Address - Fax:970-619-6990
Practice Address - Street 1:1625 FOXTRAIL DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9088
Practice Address - Country:US
Practice Address - Phone:970-619-6900
Practice Address - Fax:970-619-6990
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS37737Medicare UPIN
COP00310425Medicare PIN
COC803378Medicare PIN