Healthcare Provider Details

I. General information

NPI: 1003710195
Provider Name (Legal Business Name): MICKAELA MCCREERY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 W COLFAX AVE STE B200
LAKEWOOD CO
80215-3736
US

IV. Provider business mailing address

40815 JADE DR
AULT CO
80610-9618
US

V. Phone/Fax

Practice location:
  • Phone: 303-993-1330
  • Fax: 303-647-3647
Mailing address:
  • Phone: 303-993-1330
  • Fax: 303-647-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1770322299
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: