Healthcare Provider Details

I. General information

NPI: 1780516476
Provider Name (Legal Business Name): KYLE M BOX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E KEN PRATT BLVD STE 302
LONGMONT CO
80504-5311
US

IV. Provider business mailing address

150 MAIN ST UNIT 2410
LONGMONT CO
80501-6792
US

V. Phone/Fax

Practice location:
  • Phone: 303-684-1900
  • Fax:
Mailing address:
  • Phone: 303-684-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1691078
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: