Healthcare Provider Details

I. General information

NPI: 1982174017
Provider Name (Legal Business Name): DUSTIN ALLEN TAYLOR FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2018
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 W 84TH CIR
ARVADA CO
80003-1180
US

IV. Provider business mailing address

518 HARRISON AVE
LEADVILLE CO
80461-3558
US

V. Phone/Fax

Practice location:
  • Phone: 720-500-5488
  • Fax:
Mailing address:
  • Phone: 720-500-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0101319-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: