Healthcare Provider Details

I. General information

NPI: 1619704350
Provider Name (Legal Business Name): ALLISON MAE PORTER-PRIESKORN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 N DOLORES RD
CORTEZ CO
81321-8924
US

IV. Provider business mailing address

PO BOX 296
YELLOW JACKET CO
81335-0296
US

V. Phone/Fax

Practice location:
  • Phone: 970-564-8086
  • Fax:
Mailing address:
  • Phone: 970-529-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1000150-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: