Provider Demographics
NPI:1366548851
Name:HARROLD, PAMELA K (PA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:HARROLD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 S LEMAY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3959
Mailing Address - Country:US
Mailing Address - Phone:970-484-1757
Mailing Address - Fax:970-484-9924
Practice Address - Street 1:1107 S LEMAY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-484-1757
Practice Address - Fax:970-484-9924
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant