Healthcare Provider Details

I. General information

NPI: 1992331573
Provider Name (Legal Business Name): KRYSTAL NICOLE SHELTON PMHNP, FNP, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAL NICOLE RICHARD SMITH

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12760 STROH RANCH WAY STE 203
PARKER CO
80134-7507
US

IV. Provider business mailing address

16592 HIGH DESERT PL
PARKER CO
80134-3044
US

V. Phone/Fax

Practice location:
  • Phone: 720-458-5413
  • Fax: 720-815-0397
Mailing address:
  • Phone: 720-458-5413
  • Fax: 720-815-0397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0104280-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-146984
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: