Facts
- Status
- A
- Credential
- PA-C
- Type
- Individual
- Enumeration date
- 2026-05-06
- Last updated
- 2026-05-21
Specialties
Licenses
- License CO
- 1245404
Location
- Practice location
- 1650 COCKRANE CIRCLE
- City
- FT CARSON CO
- Postal code
- 80913
- Phone
- 719-524-2047
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.