Provider Demographics
NPI:1740766658
Name:BASSETT, JACLYN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANN
Last Name:BASSETT
Suffix:
Gender:F
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 1:8080 PARK MEADOWS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2558
Mailing Address - Country:US
Mailing Address - Phone:303-346-8828
Mailing Address - Fax:
Practice Address - Street 1:8080 PARK MEADOWS DR STE 100
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-346-8828
Practice Address - Fax:303-346-0407
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005433363AM0700X
CO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant