Healthcare Provider Details

I. General information

NPI: 1457172975
Provider Name (Legal Business Name): ERIC BRANDON RAYNOR PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N 12TH ST
GRAND JUNCTION CO
81506-2863
US

IV. Provider business mailing address

PO BOX 10700
GRAND JUNCTION CO
81502-5517
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-5707
  • Fax: 970-242-7245
Mailing address:
  • Phone: 970-242-5707
  • Fax: 970-242-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1000185-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: