Provider Demographics
NPI:1942851647
Name:DEYOUNG, SAMANTHA CLARE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CLARE
Last Name:DEYOUNG
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 1:1601 E 19TH AVE STE 6100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1255
Mailing Address - Country:US
Mailing Address - Phone:303-322-2206
Mailing Address - Fax:303-861-0191
Practice Address - Street 1:1601 E 19TH AVE STE 6100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1255
Practice Address - Country:US
Practice Address - Phone:303-322-2206
Practice Address - Fax:303-861-0191
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005961363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0005961OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
1167601OtherNCCPA