Healthcare Provider Details

I. General information

NPI: 1790320844
Provider Name (Legal Business Name): KALENE MEARS ETHINGTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALENE MEARS

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 WALTERS CREEK DR
MONUMENT CO
80132-7941
US

IV. Provider business mailing address

188 WALTERS CREEK DR
MONUMENT CO
80132-7941
US

V. Phone/Fax

Practice location:
  • Phone: 509-230-8979
  • Fax:
Mailing address:
  • Phone: 509-230-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0996115-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0001739-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: