Provider Demographics
NPI:1710054143
Name:MOON, ANDREA PATT (PA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:PATT
Last Name:MOON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:303-814-0505
Practice Address - Street 1:7280 LAGAE RD STE J
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9454
Practice Address - Country:US
Practice Address - Phone:303-814-0505
Practice Address - Fax:303-814-6491
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-09-30
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Provider Licenses
StateLicense IDTaxonomies
CO2104363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000157407Medicaid