Healthcare Provider Details

I. General information

NPI: 1215661137
Provider Name (Legal Business Name): DAVID LEONARD PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 KITTREDGE LOOP DRIVE KITTREDGE WEST HALL EAST WING
BOULDER CO
80310-0001
US

IV. Provider business mailing address

307 E IOWA AVE
BERTHOUD CO
80513-1461
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-2277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0997313-NP
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: