Provider Demographics
NPI:1447730130
Name:SUMMERILL, LINDSAY KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:KATHERINE
Last Name:SUMMERILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:KATHERINE
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1960 N OGDEN ST STE 550
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3676
Mailing Address - Country:US
Mailing Address - Phone:303-812-6850
Mailing Address - Fax:303-812-6859
Practice Address - Street 1:1960 N OGDEN ST STE 550
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3676
Practice Address - Country:US
Practice Address - Phone:303-812-6850
Practice Address - Fax:303-812-6859
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
14367800OtherCAQH
PA103568388Medicaid