Healthcare Provider Details

I. General information

NPI: 1205420056
Provider Name (Legal Business Name): MICHELLE EGBERT FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5278 FRASER VALLEY LN
COLORADO SPRINGS CO
80924-8205
US

IV. Provider business mailing address

3720 SINTON RD STE 104
COLORADO SPRINGS CO
80907-5085
US

V. Phone/Fax

Practice location:
  • Phone: 719-826-6605
  • Fax: 719-888-1718
Mailing address:
  • Phone: 719-493-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996218-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996218-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: