Healthcare Provider Details

I. General information

NPI: 1386327526
Provider Name (Legal Business Name): FLYWELL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 TUTT BLVD STE 120
COLORADO SPRINGS CO
80923-3574
US

IV. Provider business mailing address

6140 TUTT BLVD STE 120
COLORADO SPRINGS CO
80923-3574
US

V. Phone/Fax

Practice location:
  • Phone: 719-888-5181
  • Fax:
Mailing address:
  • Phone: 719-888-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICE KIESLING
Title or Position: OWNER
Credential: FNP
Phone: 719-888-5181