Provider Demographics
NPI:1295985810
Name:PHIPPS, AIMEE LYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:LYN
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AIMEE
Other - Middle Name:LYN
Other - Last Name:BOLLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NOT AVAILABLE
Mailing Address - Street 1:3205 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5101
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:719-344-7837
Practice Address - Street 1:410 GOLD PASS HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3882
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-344-7817
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2670363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52681548Medicaid
COCOAAA3812OtherMEDICARE NUMBER