Provider Demographics
NPI:1700945094
Name:STOCK, JO ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JO
Middle Name:ANN
Last Name:STOCK
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:PO BOX 6000
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-0600
Mailing Address - Country:US
Mailing Address - Phone:970-521-8814
Mailing Address - Fax:970-521-8815
Practice Address - Street 1:12101 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-8428
Practice Address - Country:US
Practice Address - Phone:970-521-8814
Practice Address - Fax:970-521-8815
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1304363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical