Provider Demographics
NPI:1497997266
Name:PASCHALL, AMANDA JOY (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:PASCHALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOY
Other - Last Name:CAIRNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1345 PLAZA COURT NORTH
Mailing Address - Street 2:#1A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2832
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:720-206-0434
Practice Address - Street 1:8990 N. WASHINGTON
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4537
Practice Address - Country:US
Practice Address - Phone:720-929-1655
Practice Address - Fax:720-206-0434
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0006007NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89688341Medicaid
CO89688341Medicaid