Provider Demographics
NPI:1902074255
Name:CHADEZ, TAMMY S (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:S
Last Name:CHADEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:S
Other - Last Name:KLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2515 FORESIGHT CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1018
Mailing Address - Country:US
Mailing Address - Phone:970-245-2400
Mailing Address - Fax:970-242-9092
Practice Address - Street 1:2515 FORESIGHT CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1018
Practice Address - Country:US
Practice Address - Phone:970-242-8177
Practice Address - Fax:970-255-3558
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002572363AM0700X, 363AS0400X
COPA-2572363AM0700X, 363AS0400X
CO2572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37777262Medicaid