Healthcare Provider Details

I. General information

NPI: 1780245761
Provider Name (Legal Business Name): KEITH SANDERS POSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E FONTANERO ST STE 308
COLORADO SPRINGS CO
80907-7526
US

IV. Provider business mailing address

320 E. FONTANERO, SUITE 308
COLORADO SPRINGS CO
80907-7526
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-4200
  • Fax:
Mailing address:
  • Phone: 719-577-4200
  • Fax: 719-442-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994711-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: