ROCKY MOUNTAIN PRIMARY CARE CLINIC NPI 1720385016

NPI Information

ROCKY MOUNTAIN PRIMARY CARE CLINIC is a family nurse practitioner in Pueblo, CO. ROCKY MOUNTAIN PRIMARY CARE CLINIC NPI is 1720385016. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

131 S MAIN ST
SUITE 101
PUEBLO, CO
ZIP 81003-415
Phone: (719) 924-9398
Fax: (719) 924-9593

The provider's authorized official is Ashley N. Kirby .
The authorized official title is Nurse Practitioner/owner and has the following contact phone number (719) 924-9398.

The CLIA number assigned to this NPI record is 06D2025909 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/22/2011 and was last updated on 3/8/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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