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NPI Code Detail

MEDICARE: PSYCH NP PLLC

MEDICARE: PSYCH NP PLLC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1538904735
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSYCH NP PLLC
Provider Business Mailing Address
First Line : 2320 W COLORADO AVE STE 118
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-3354
Country : US
Telephone Number : 719-581-7110
Fax Number : 719-581-7114
Provider Business Practice Location Address
First Line : 2320 W COLORADO AVE STE 118
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-3354
Country : US
Telephone Number : 719-581-7110
Fax Number : 719-581-7114
Authorized Official
Title or Position : OWNER, PMHNP
Name : SHANNON STONE
Credential :
Telephone Number : 719-581-7110
Provider Enumeration Date : 06/28/2024
Last Update Date : 01/07/2025

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