Provider Demographics
NPI:1659632040
Name:FELL, JAIME LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:FELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9235 CROWN CREST BLVD
Mailing Address - Street 2:100
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8880
Mailing Address - Country:US
Mailing Address - Phone:303-695-7667
Mailing Address - Fax:303-695-8146
Practice Address - Street 1:9235 CROWN CREST BLVD
Practice Address - Street 2:100
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8880
Practice Address - Country:US
Practice Address - Phone:303-695-7667
Practice Address - Fax:303-695-8146
Is Sole Proprietor?:No
Enumeration Date:2012-06-02
Last Update Date:2012-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1758363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical