Healthcare Provider Details

I. General information

NPI: 1497100390
Provider Name (Legal Business Name): KANCHAN BHOWMIK PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 LARIMER PKWY
JOHNSTOWN CO
80534-8912
US

IV. Provider business mailing address

2405 MIDPOINT DR
FORT COLLINS CO
80525-4419
US

V. Phone/Fax

Practice location:
  • Phone: 970-461-5061
  • Fax:
Mailing address:
  • Phone: 970-577-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1621971
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0995127-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: