Healthcare Provider Details

I. General information

NPI: 1740545227
Provider Name (Legal Business Name): VANNA KAY IRVING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANNA KAY GORDON

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W HWY 50
SALIDA CO
81201-2238
US

IV. Provider business mailing address

550 W HWY 50
SALIDA CO
81201-2238
US

V. Phone/Fax

Practice location:
  • Phone: 719-530-2022
  • Fax: 719-539-2375
Mailing address:
  • Phone: 195-302-0227
  • Fax: 719-539-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015-01300
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: