Provider Demographics
NPI:1528296381
Name:PUSEY, CANDICE DORRIS (PA-C)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:DORRIS
Last Name:PUSEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17560 S GOLDEN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6005
Mailing Address - Country:US
Mailing Address - Phone:303-526-1117
Mailing Address - Fax:303-278-0611
Practice Address - Street 1:17560 S GOLDEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6005
Practice Address - Country:US
Practice Address - Phone:303-526-1117
Practice Address - Fax:303-278-0611
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2791207R00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2791OtherCO STATE LICENSE