Provider Demographics
NPI:1447414172
Name:CHEYENNE MOUNTAIN FAMILY PRACTICE
Entity Type:Organization
Organization Name:CHEYENNE MOUNTAIN FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:STARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:719-634-4746
Mailing Address - Street 1:125 SWOPE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5832
Mailing Address - Country:US
Mailing Address - Phone:719-634-4746
Mailing Address - Fax:719-634-5024
Practice Address - Street 1:125 SWOPE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5832
Practice Address - Country:US
Practice Address - Phone:719-634-4746
Practice Address - Fax:719-634-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO126800364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty