Healthcare Provider Details

I. General information

NPI: 1831901008
Provider Name (Legal Business Name): KYLE CHRISTOPHER BANGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 PENNOCK PL STE 114
FORT COLLINS CO
80524-3250
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8800
  • Fax: 970-495-8820
Mailing address:
  • Phone: 970-624-2421
  • Fax: 970-490-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.1000549-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: