Healthcare Provider Details

I. General information

NPI: 1477260917
Provider Name (Legal Business Name): NICOLE LYNN LOYD MASTERS STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 12TH ST STE 220
GOLDEN CO
80401-1231
US

IV. Provider business mailing address

1030 JOHNSON RD STE 320
GOLDEN CO
80401-6049
US

V. Phone/Fax

Practice location:
  • Phone: 303-850-2695
  • Fax:
Mailing address:
  • Phone: 720-805-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0024125
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: