Healthcare Provider Details

I. General information

NPI: 1013492719
Provider Name (Legal Business Name): KARLA RAE RICHARDSON-TRUJILLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 W 16TH ST
PUEBLO CO
81003-2728
US

IV. Provider business mailing address

27800 E US HIGHWAY 50
PUEBLO CO
81006-9112
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-3511
  • Fax:
Mailing address:
  • Phone: 719-406-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.0169437
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994361
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: