Healthcare Provider Details

I. General information

NPI: 1447414172
Provider Name (Legal Business Name): CHEYENNE MOUNTAIN FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SWOPE AVE
COLORADO SPRINGS CO
80909-5832
US

IV. Provider business mailing address

125 SWOPE AVE
COLORADO SPRINGS CO
80909-5832
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-4746
  • Fax: 719-634-5024
Mailing address:
  • Phone: 719-634-4746
  • Fax: 719-634-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number126800
License Number StateCO

VIII. Authorized Official

Name: MRS. BARBARA JEAN STARKEY
Title or Position: PRESIDENT
Credential: FNP
Phone: 719-634-4746