Healthcare Provider Details

I. General information

NPI: 1598610354
Provider Name (Legal Business Name): LUCAS BETLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12650 W 64TH AVE UNIT E501
ARVADA CO
80004-3887
US

IV. Provider business mailing address

12650 W 64TH AVE UNIT E501
ARVADA CO
80004-3887
US

V. Phone/Fax

Practice location:
  • Phone: 303-431-4127
  • Fax: 303-431-4553
Mailing address:
  • Phone: 303-431-4127
  • Fax: 303-431-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010016
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: