Healthcare Provider Details

I. General information

NPI: 1598638264
Provider Name (Legal Business Name): NINO NGUYEN SYKES PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2025
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 LUNA DR
FOUNTAIN CO
80817-1116
US

IV. Provider business mailing address

1620 LUNA DR
FOUNTAIN CO
80817-1116
US

V. Phone/Fax

Practice location:
  • Phone: 719-237-3057
  • Fax:
Mailing address:
  • Phone: 719-237-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1001202-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: