| NPI | 1679278485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN A KOURY Co Owner 719-298-4430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-07-27 |