Healthcare Provider Details

I. General information

NPI: 1740825629
Provider Name (Legal Business Name): DENISE SMITH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CEDAR RIDGE RD
MOSCA CO
81146-9522
US

IV. Provider business mailing address

23 CEDAR RIDGE RD
MOSCA CO
81146-9522
US

V. Phone/Fax

Practice location:
  • Phone: 719-298-6600
  • Fax:
Mailing address:
  • Phone: 719-298-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number67048
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0995177-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number67048
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0995177-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: