Healthcare Provider Details

I. General information

NPI: 1306263181
Provider Name (Legal Business Name): SHAWN A. KOURY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWN A. KOURY NP

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N MAIN ST
PUEBLO CO
81003-2826
US

IV. Provider business mailing address

1104 N MAIN ST
PUEBLO CO
81003-2826
US

V. Phone/Fax

Practice location:
  • Phone: 719-298-4430
  • Fax:
Mailing address:
  • Phone: 719-298-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0991118-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991118-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0101601-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: