Healthcare Provider Details

I. General information

NPI: 1508337916
Provider Name (Legal Business Name): OWENS & PORTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 REDWING RD STE 110
FORT COLLINS CO
80526-2878
US

IV. Provider business mailing address

2625 REDWING RD STE 110
FORT COLLINS CO
80526-2878
US

V. Phone/Fax

Practice location:
  • Phone: 720-897-5722
  • Fax: 727-800-2333
Mailing address:
  • Phone: 720-897-5722
  • Fax: 727-800-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT OWENS
Title or Position: CHIEF MEDICAL OFFICER
Credential: PMHNP-BC
Phone: 513-324-0909