Provider Demographics
NPI:1154486686
Name:BROWN, JESSICA DAWN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DAWN
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:FINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2955 VALMONT RD
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1396
Mailing Address - Country:US
Mailing Address - Phone:303-440-7525
Mailing Address - Fax:303-440-4215
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:LUTHERAN MEDICAL CENTER E.D.
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-440-7525
Practice Address - Fax:303-440-4215
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP03906Medicare UPIN
CO517048Medicare ID - Type UnspecifiedPROVIDER NUMBER