Healthcare Provider Details

I. General information

NPI: 1932486933
Provider Name (Legal Business Name): BENJAMIN KIRBY FERRELL APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 28 3/4 RD
GRAND JUNCTION CO
81501-5016
US

IV. Provider business mailing address

715 HORIZON DR STE 225
GRAND JUNCTION CO
81506-8743
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-4918
  • Fax: 970-683-7278
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0990299-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: