Healthcare Provider Details

I. General information

NPI: 1558627141
Provider Name (Legal Business Name): TARA COURTNEY CALLOW CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2012
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S CHERRY ST STE 410
DENVER CO
80246-2664
US

IV. Provider business mailing address

950 S CHERRY ST STE 410
DENVER CO
80246-2664
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-5577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-RXN.0100260-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-15798
License Number StateZZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11016172
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: