Provider Demographics
NPI:1457607921
Name:COTTER, VALERIE A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:A
Last Name:COTTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:A
Other - Last Name:KREBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2635 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8209
Mailing Address - Country:US
Mailing Address - Phone:970-298-2273
Mailing Address - Fax:
Practice Address - Street 1:2686 PATTERSON RD
Practice Address - Street 2:SMMG PHYS MED & REHAB
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8817
Practice Address - Country:US
Practice Address - Phone:970-298-2023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84870583Medicaid
CO84870583Medicaid