Provider Demographics
NPI:1710458179
Name:STICKNEY, TRENTON (PA-C)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:
Last Name:STICKNEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4743 ARAPAHOE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1128
Mailing Address - Country:US
Mailing Address - Phone:303-938-5700
Mailing Address - Fax:303-998-0007
Practice Address - Street 1:4743 ARAPAHOE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1128
Practice Address - Country:US
Practice Address - Phone:303-938-5700
Practice Address - Fax:303-998-0007
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006080363A00000X
COPA.0006080363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty