Provider Demographics
NPI:1710983655
Name:RICHEY, MELINDA ANN (PA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:RICHEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ANN
Other - Last Name:MACKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8580 SCARBOROUGH DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7583
Mailing Address - Country:US
Mailing Address - Phone:719-359-9669
Mailing Address - Fax:719-531-9645
Practice Address - Street 1:8580 SCARBOROUGH DR
Practice Address - Street 2:SUITE 225
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7583
Practice Address - Country:US
Practice Address - Phone:719-359-9669
Practice Address - Fax:719-531-9645
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005406363AM0700X, 363A00000X
CO3609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P96355Medicare UPIN