Provider Demographics
NPI:1477920908
Name:FAILLA, CATHLEEN MARIE (PA)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:MARIE
Last Name:FAILLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:MARIE
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9320 GRAND CORDERA PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7004
Mailing Address - Country:US
Mailing Address - Phone:719-418-3839
Mailing Address - Fax:719-282-0532
Practice Address - Street 1:4105 BRIARGATE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3484
Practice Address - Country:US
Practice Address - Phone:719-364-2800
Practice Address - Fax:719-364-2801
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005392207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV1969AMedicare PIN