Active NPI
Anna Sergeevna Chuklanov, PA
- Medical Physician Assistant
- Colorado Springs, CO
National Provider Identifier
1164753349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 2855
- Practice address
- 115 S Parkside Dr
Colorado Springs, CO 80910-3130 - Phone
- (719) 635-7000
- NPI assigned
- Jan 27, 2010
- Last updated
- Jul 25, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 2855 | CO | Primary |
Addresses
Primary practice location
115 S Parkside Dr
Colorado Springs, CO 80910-3130
Mailing address
1364 S Zeno St
Aurora, CO 80017-4324
Phone (303) 803-2097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2855 | CO | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374710400000",
"number": "1164753349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1364 S ZENO ST",
"city": "AURORA",
"state": "CO",
"postal_code": "800174324",
"telephone_number": "303-803-2097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 S PARKSIDE DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809103130",
"telephone_number": "719-635-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUKLANOV",
"first_name": "ANNA",
"middle_name": "SERGEEVNA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-27",
"last_updated": "2013-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CO",
"license": "2855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.