Provider Demographics
NPI:1013492719
Name:RICHARDSON-TRUJILLO, KARLA RAE (FNP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:RAE
Last Name:RICHARDSON-TRUJILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27800 E US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81006-9112
Mailing Address - Country:US
Mailing Address - Phone:719-406-5309
Mailing Address - Fax:
Practice Address - Street 1:314 W 16TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2728
Practice Address - Country:US
Practice Address - Phone:719-546-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0169437163WG0000X
COAPN.0994361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice