MEDICARE: MARISSA MEREDITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.9503	CO

General Provider Information

NPI Number	:	1033009980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA MEREDITH

Provider Business Mailing Address
First Line	:	777 BANNOCK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-436-4949
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 BANNOCK ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-436-4949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	12/17/2025

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Directions to “ MARISSA MEREDITH ” Practice Location

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