Provider Demographics
NPI:1053355263
Name:PACHECO, JAIMEE R (PA-C)
Entity type:Individual
Prefix:
First Name:JAIMEE
Middle Name:R
Last Name:PACHECO
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 1:7400 E CRESTLINE CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3652
Mailing Address - Country:US
Mailing Address - Phone:303-792-3242
Mailing Address - Fax:303-792-9403
Practice Address - Street 1:7400 E CRESTLINE CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3652
Practice Address - Country:US
Practice Address - Phone:303-792-3242
Practice Address - Fax:303-792-9403
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1799363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q06543Medicare UPIN