=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992485833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALLIE WAKELY STONE FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2023
-----------------------------------------------------
Last Update Date | 08/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1335 E SOUTH BOULDER RD STE C
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-961-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7951 E MAPLEWOOD AVE STE 350
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-4758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-930-7895
-----------------------------------------------------
Fax | 832-601-6018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APN.0998951-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------