Healthcare Provider Details

I. General information

NPI: 1306763503
Provider Name (Legal Business Name): SHAWNA MOORHEAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S PARKSIDE DR
COLORADO SPRINGS CO
80910-3134
US

IV. Provider business mailing address

8950 BALDERDASH DR
COLORADO SPRINGS CO
80924-5332
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-8000
  • Fax:
Mailing address:
  • Phone: 719-373-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001600-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: