Provider Demographics
NPI:1356190995
Name:CASADOS, PAUL ANTHONY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:CASADOS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1242
Mailing Address - Country:US
Mailing Address - Phone:719-320-9072
Mailing Address - Fax:
Practice Address - Street 1:635 W CORONA AVE STE 205
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1210
Practice Address - Country:US
Practice Address - Phone:719-553-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999732-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health