Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob Daniel Shirley, PA

Individual provider Physician Assistant · NPI 1992463970

Jacob Daniel Shirley, PA is a Physician Assistant in Longmont, Colorado. Qualified in 2021, 5 years ago. Practices with Poudre Valley Medical Group LLC, a 2,416-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Colorado, Idaho and Wyoming.

Years since qualifying
5
Licensed in
CO, ID, WY
In the registry since
2021
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1925 Mountain View Ave Fl 3
Longmont, CO 80501-3128
Phone: (720) 718-8240
Fax: (720) 718-0953
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0009178 (CO)
Physician Assistant Taxonomy 363A00000X · Licence PA1128 (WY)
Physician Assistant Taxonomy 363A00000X · Licence PA-2185 (ID)

Record details

NPI number1992463970
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedDecember 7, 2021
Last updated in NPPESJuly 23, 2025
Certification dateJuly 23, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Poudre Valley Medical Group Llc — 2416 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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