Provider Demographics
NPI:1477002020
Name:GASPER, NATHAN (AGACNP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:GASPER
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 PHAY AVE BLDG D
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2326
Mailing Address - Country:US
Mailing Address - Phone:719-285-2646
Mailing Address - Fax:719-285-2647
Practice Address - Street 1:1919 W US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008
Practice Address - Country:US
Practice Address - Phone:719-253-7102
Practice Address - Fax:719-253-7114
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0992377-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO536437YTH8Medicare UPIN