Healthcare Provider Details

I. General information

NPI: 1295252781
Provider Name (Legal Business Name): JAMES TRAVIS KUSTER APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BALSAM AVE FL 3
BOULDER CO
80304-3404
US

IV. Provider business mailing address

4141 ARAPAHOE AVE STE 100
BOULDER CO
80303-1032
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-2277
  • Fax: 303-440-2353
Mailing address:
  • Phone: 303-440-2277
  • Fax: 303-440-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1627358
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0993382-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: