Healthcare Provider Details

I. General information

NPI: 1144827825
Provider Name (Legal Business Name): KRS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KEN PRATT BLVD STE 106
LONGMONT CO
80501-6454
US

IV. Provider business mailing address

3362 DOVETAIL DR
BERTHOUD CO
80513-8931
US

V. Phone/Fax

Practice location:
  • Phone: 623-363-1185
  • Fax:
Mailing address:
  • Phone: 623-363-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT WILLIAM HORTON
Title or Position: MEDICAL DIRECTOR AND OWNER
Credential: NP
Phone: 623-363-1185