Provider Demographics
NPI:1518177096
Name:BAILEY, KATRINA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4743 ARAPAHOE AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1123
Mailing Address - Country:US
Mailing Address - Phone:303-444-9000
Mailing Address - Fax:
Practice Address - Street 1:120 OLD LARAMIE TRL STE 202
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7012
Practice Address - Country:US
Practice Address - Phone:303-444-0840
Practice Address - Fax:303-444-0838
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09383751Medicaid
CO09383751Medicaid
CO09383751Medicaid