Healthcare Provider Details

I. General information

NPI: 1962377945
Provider Name (Legal Business Name): RACHEL MARIE CARSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 6TH ST
HUGO CO
80821-2002
US

IV. Provider business mailing address

PO BOX 372
HUGO CO
80821-0372
US

V. Phone/Fax

Practice location:
  • Phone: 719-743-2421
  • Fax: 719-743-2421
Mailing address:
  • Phone: 719-740-0562
  • Fax: 719-740-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001287-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: