Provider Demographics
NPI:1922362201
Name:GARRATY, PAUL G (NP-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:G
Last Name:GARRATY
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 FRONT ST UNIT B-158
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7902
Mailing Address - Country:US
Mailing Address - Phone:970-549-6875
Mailing Address - Fax:949-222-2088
Practice Address - Street 1:9233 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5697
Practice Address - Country:US
Practice Address - Phone:970-549-6875
Practice Address - Fax:949-222-2088
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO184839163W00000X
CONP990417363LF0000X
COAPN.0990417-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20283865Medicaid
CO260711YL92Medicare PIN