=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275657330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THREE PEAKS INTEGRATIVE FAMILY MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1236 E ELIZABETH ST SUITE 2
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-221-9970
-----------------------------------------------------
Fax | 970-221-9971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1236 E ELIZABETH ST SUITE 2
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-221-9970
-----------------------------------------------------
Fax | 970-221-9971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. NICKI RAE CARTER
-----------------------------------------------------
Credential | MS, FNPC
-----------------------------------------------------
Telephone | 970-221-9970
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 18870
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------