Healthcare Provider Details

I. General information

NPI: 1689948424
Provider Name (Legal Business Name): DIANA SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W CORONA AVE STE 205
PUEBLO CO
81004-1210
US

IV. Provider business mailing address

635 W CORONA AVE STE 205
PUEBLO CO
81004-1210
US

V. Phone/Fax

Practice location:
  • Phone: 719-553-7521
  • Fax: 719-229-4672
Mailing address:
  • Phone: 719-553-7521
  • Fax: 719-229-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0991239-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number991239
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN.0081430
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN81430
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: