Provider Demographics
NPI:1194965384
Name:CORLEY, LISA M (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CORLEY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:719-538-2990
Practice Address - Street 1:700 W US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8975
Practice Address - Country:US
Practice Address - Phone:719-522-1133
Practice Address - Fax:719-687-8919
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2025-11-05
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Provider Licenses
StateLicense IDTaxonomies
COPA.9459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant