MEDICARE: ANGELA WALSH KOONS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP139684	TX
2	363LF0000X	Family Nurse Practitioner	C-APN.0100812	CO

General Provider Information

NPI Number	:	1295204618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WALSH KOONS APRN

Provider Business Mailing Address
First Line	:	1554 N EMERSON ST UNIT 5
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1450
Country	:	US
Telephone Number	:	720-358-2862
Fax Number	:	833-358-2800

Provider Business Practice Location Address
First Line	:	1554 N EMERSON ST UNIT 5
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1450
Country	:	US
Telephone Number	:	720-358-2862
Fax Number	:	833-358-2800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	10/31/2023

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