Provider Demographics
NPI:1720065956
Name:MEYER, CARRIE A (PA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:MEYER
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 1:2352 MEADOWS BLVD STE 145
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8406
Mailing Address - Country:US
Mailing Address - Phone:720-528-0860
Mailing Address - Fax:720-528-0861
Practice Address - Street 1:2352 MEADOWS BLVD STE 145
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8406
Practice Address - Country:US
Practice Address - Phone:720-528-0860
Practice Address - Fax:720-528-0861
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002134363A00000X
CO0003814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMUPA24581Medicare ID - Type Unspecified
OHQ38790Medicare UPIN