Healthcare Provider Details

I. General information

NPI: 1750400933
Provider Name (Legal Business Name): RICKY ALLEN MONETT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
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

30691 BARNETT RD
PUEBLO CO
81006-9544
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-3511
  • Fax: 719-583-1292
Mailing address:
  • Phone: 719-253-0455
  • Fax: 719-546-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number99869
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: