Healthcare Provider Details

I. General information

NPI: 1326727017
Provider Name (Legal Business Name): HEIDI KATHLEEN LARRICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E RAILROAD AVE
MANCOS CO
81328-9329
US

IV. Provider business mailing address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

V. Phone/Fax

Practice location:
  • Phone: 970-533-9125
  • Fax:
Mailing address:
  • Phone: 970-459-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0998906-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1627658
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: