Healthcare Provider Details

I. General information

NPI: 1366114860
Provider Name (Legal Business Name): FERDINAND ULRICH YOUSSA MOUNGOUE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 FISH HATCHERY RD
ESTES PARK CO
80517-9227
US

IV. Provider business mailing address

1600 FISH HATCHERY RD
ESTES PARK CO
80517-9227
US

V. Phone/Fax

Practice location:
  • Phone: 970-340-2228
  • Fax:
Mailing address:
  • Phone: 970-340-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996996-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996996-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: