Healthcare Provider Details

I. General information

NPI: 1609797075
Provider Name (Legal Business Name): KRISTA VAN SLYKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W 14TH ST STE A
RIFLE CO
81650-4717
US

IV. Provider business mailing address

195 W 14TH ST STE A
RIFLE CO
81650-4717
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1648919
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: