Healthcare Provider Details

I. General information

NPI: 1750824843
Provider Name (Legal Business Name): KRISTY BLOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S 9TH ST
CANON CITY CO
81212-4911
US

IV. Provider business mailing address

802 E 5TH ST
FLORENCE CO
81226-1610
US

V. Phone/Fax

Practice location:
  • Phone: 719-269-8820
  • Fax: 719-204-0230
Mailing address:
  • Phone: 719-214-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0992763
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: