Provider Demographics
NPI:1457651598
Name:FARROW, STACIE LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LEIGH
Last Name:FARROW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19641 E PARKER SQUARE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7399
Mailing Address - Country:US
Mailing Address - Phone:303-840-3800
Mailing Address - Fax:303-840-8442
Practice Address - Street 1:19641 E PARKER SQUARE DR
Practice Address - Street 2:SUITE A
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7399
Practice Address - Country:US
Practice Address - Phone:303-840-3800
Practice Address - Fax:303-840-8442
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-178453163W00000X
CONP-10343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMF2441638OtherDEA