Healthcare Provider Details

I. General information

NPI: 1578119541
Provider Name (Legal Business Name): HAILEY KEPLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

2712 HARVARD ST
FORT COLLINS CO
80525-2147
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-1900
  • Fax:
Mailing address:
  • Phone: 970-217-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994917-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: