Healthcare Provider Details

I. General information

NPI: 1194028159
Provider Name (Legal Business Name): CARRIE ANN CHANOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 RIDGELINE BLVD STE 190
HIGHLANDS RANCH CO
80129-2395
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 450
HIGHLANDS RANCH CO
80129-2255
US

V. Phone/Fax

Practice location:
  • Phone: 720-828-7755
  • Fax: 720-828-7901
Mailing address:
  • Phone: 303-357-2559
  • Fax: 720-828-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2254
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: