Provider Demographics
NPI:1972043396
Name:CREEKMORE, DARRELL JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:JOSEPH
Last Name:CREEKMORE
Suffix:
Gender:M
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 1:777 29TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2316
Mailing Address - Country:US
Mailing Address - Phone:303-440-8243
Mailing Address - Fax:303-440-0292
Practice Address - Street 1:777 29TH ST STE 301
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2316
Practice Address - Country:US
Practice Address - Phone:303-440-8243
Practice Address - Fax:303-440-0292
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007469363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant