Provider Demographics
NPI:1699917567
Name:GARDNER, PAULA SKYE (PA-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:SKYE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:SKYE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:940 CENTRAL PARK DR.
Mailing Address - Street 2:STE 210
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487
Mailing Address - Country:US
Mailing Address - Phone:970-871-4811
Mailing Address - Fax:970-879-4527
Practice Address - Street 1:940 CENTRAL PARK DR.
Practice Address - Street 2:STE 210
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-871-4811
Practice Address - Fax:970-879-4527
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012966-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03120376Medicaid