Healthcare Provider Details

I. General information

NPI: 1538078167
Provider Name (Legal Business Name): MALLORY KRISTENE HUBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11463 W 67TH AVE
ARVADA CO
80004-2582
US

IV. Provider business mailing address

11463 W 67TH AVE
ARVADA CO
80004-2582
US

V. Phone/Fax

Practice location:
  • Phone: 303-847-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1002367.NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: