Provider Demographics
NPI:1679850341
Name:UNDERHILL, ANNE C (PA)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:C
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:K
Other - Last Name:CAULK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3027 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1179
Mailing Address - Country:US
Mailing Address - Phone:719-776-3216
Mailing Address - Fax:719-776-3220
Practice Address - Street 1:3027 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1179
Practice Address - Country:US
Practice Address - Phone:719-776-3216
Practice Address - Fax:719-776-3220
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0000563363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19870051Medicaid