Healthcare Provider Details

I. General information

NPI: 1144927625
Provider Name (Legal Business Name): CARLA M MCCALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 CLEAR SPRING AVE
DURANGO CO
81301-6605
US

IV. Provider business mailing address

442 CLEAR SPRING AVE
DURANGO CO
81301-6605
US

V. Phone/Fax

Practice location:
  • Phone: 970-749-2811
  • Fax:
Mailing address:
  • Phone: 970-749-2281
  • Fax: 719-297-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0998390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: