Healthcare Provider Details

I. General information

NPI: 1639393457
Provider Name (Legal Business Name): TRICIA STEPHENSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HOLLY ST
DENVER CO
80220-5828
US

IV. Provider business mailing address

620 IVY ST
DENVER CO
80220-5342
US

V. Phone/Fax

Practice location:
  • Phone: 866-484-8049
  • Fax:
Mailing address:
  • Phone: 303-601-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1213
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: