Healthcare Provider Details

I. General information

NPI: 1609305630
Provider Name (Legal Business Name): HEATHER SMALLWOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER WOHLERS

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7180 E ORCHARD RD STE 306
CENTENNIAL CO
80111-1727
US

IV. Provider business mailing address

9590 S ESTES WAY
LITTLETON CO
80127-8512
US

V. Phone/Fax

Practice location:
  • Phone: 720-452-7420
  • Fax: 720-466-4174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0004988
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: