Healthcare Provider Details

I. General information

NPI: 1134501026
Provider Name (Legal Business Name): CARRIE DOWNEY WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 03/14/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ST MDG 559 VINCENT ST
PETERSON AFB CO
80914-1540
US

IV. Provider business mailing address

21ST MDG 559 VINCENT ST
PSFB CO
80914-1540
US

V. Phone/Fax

Practice location:
  • Phone: 519-556-5898
  • Fax:
Mailing address:
  • Phone: 719-556-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number76830
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: