Healthcare Provider Details

I. General information

NPI: 1679278485
Provider Name (Legal Business Name): UNITY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
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: 719-251-9023
  • Fax:
Mailing address:
  • Phone: 719-298-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHAWN A KOURY
Title or Position: CO-OWNER
Credential: NP
Phone: 719-298-4430