Healthcare Provider Details

I. General information

NPI: 1023714094
Provider Name (Legal Business Name): STARLIGHT HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 01/10/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W DRAKE RD
FORT COLLINS CO
80526-2846
US

IV. Provider business mailing address

313 W DRAKE RD
FORT COLLINS CO
80526-2846
US

V. Phone/Fax

Practice location:
  • Phone: 970-632-0135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON ROGERS
Title or Position: PRESIDENT
Credential:
Phone: 970-632-0135