Healthcare Provider Details

I. General information

NPI: 1013821271
Provider Name (Legal Business Name): DIVINE HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 US HIGHWAY 50
LAMAR CO
81052-9565
US

IV. Provider business mailing address

7545 US HIGHWAY 50
LAMAR CO
81052-9565
US

V. Phone/Fax

Practice location:
  • Phone: 719-413-5261
  • Fax: 719-888-1767
Mailing address:
  • Phone: 719-413-5261
  • Fax: 719-888-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHEYENNE ELAINE SHIPMAN
Title or Position: PMHNP-BC OWNER
Credential:
Phone: 719-252-2386