Healthcare Provider Details

I. General information

NPI: 1427506807
Provider Name (Legal Business Name): KIRK FLATHERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 TESLA DR
COLORADO SPRINGS CO
80909-3232
US

IV. Provider business mailing address

1226 TESLA DR
COLORADO SPRINGS CO
80909-3232
US

V. Phone/Fax

Practice location:
  • Phone: 719-761-3432
  • Fax:
Mailing address:
  • Phone: 719-761-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: