Healthcare Provider Details

I. General information

NPI: 1841836699
Provider Name (Legal Business Name): KARISSA CAYLENE GAYOSSO AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E ELIZABETH ST STE 2
FORT COLLINS CO
80524-4044
US

IV. Provider business mailing address

PO BOX 46
ORCHARD CO
80649-0046
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-9193
  • Fax:
Mailing address:
  • Phone: 970-380-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0995052-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number76976
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0995052-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number76976
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0995052-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: