Provider Demographics
NPI:1922570621
Name:MCBRYDE, HEATHER AYNSLEY (PA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:AYNSLEY
Last Name:MCBRYDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10463 PARK MEADOWS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5317
Mailing Address - Country:US
Mailing Address - Phone:303-792-2224
Mailing Address - Fax:
Practice Address - Street 1:10463 PARK MEADOWS DR STE 110
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5317
Practice Address - Country:US
Practice Address - Phone:303-792-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant