Provider Demographics
NPI:1982801247
Name:STEWART, PAMELA F (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 COLE BLVD.
Mailing Address - Street 2:STE # 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401
Mailing Address - Country:US
Mailing Address - Phone:303-716-8018
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:200 W. COUNTY LINE RD.
Practice Address - Street 2:STE #130
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129
Practice Address - Country:US
Practice Address - Phone:303-791-0418
Practice Address - Fax:303-791-1849
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92452833Medicaid
CO92452833Medicaid