Healthcare Provider Details

I. General information

NPI: 1083541767
Provider Name (Legal Business Name): VALLEY ROOTS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 HERMIT RD
WESTCLIFFE CO
81252
US

IV. Provider business mailing address

746 COUNTY ROAD 129
WESTCLIFFE CO
81252-9309
US

V. Phone/Fax

Practice location:
  • Phone: 719-204-5137
  • Fax:
Mailing address:
  • Phone: 719-204-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BECKER
Title or Position: OWNER/ AUTHORIZED OFFICIAL
Credential: FNP
Phone: 719-204-5137