=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285851626
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSSA RHODES RICHARDSON PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 ERIE PKWY STE 201C
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80516-4072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-415-5816
-----------------------------------------------------
Fax | 303-293-0625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9049
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80301-9049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-415-5816
-----------------------------------------------------
Fax | 303-293-0625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA.0002283
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------