Provider Demographics
NPI:1982605358
Name:CALLENDER, JOY LYNN (PA)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:LYNN
Last Name:CALLENDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:2555 E 13TH ST
Practice Address - Street 2:STE 110
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5161
Practice Address - Country:US
Practice Address - Phone:970-461-6140
Practice Address - Fax:970-461-6135
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA102267Medicare PIN
P81598Medicare UPIN