Healthcare Provider Details

I. General information

NPI: 1447669460
Provider Name (Legal Business Name): COURTNEY LYNNE EDWARDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY LYNNE BRYAN PA-C

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E 19TH AVE STE 300
DENVER CO
80218-1258
US

IV. Provider business mailing address

1721 E. 19TH AVE. SUITE 200
DENVER CO
80218
US

V. Phone/Fax

Practice location:
  • Phone: 720-754-4800
  • Fax: 720-754-4801
Mailing address:
  • Phone: 720-754-4800
  • Fax: 720-754-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0004036
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: