Individual provider Active NPI

Lynne M Evetts, NP

  • Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1023054541
Registry record updated Feb 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
100124 Issued in CO
Practice address
300 Colorado Ave
Pueblo, CO 81004-2006
Phone
(719) 543-8711
Fax
(719) 543-5340
NPI assigned
Jun 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 100124 CO Primary

Addresses

Primary practice location

300 Colorado Ave
Pueblo, CO 81004-2006

Mailing address

110 E Routt Ave
Pueblo, CO 81004-2117
Phone (719) 543-8711

Other identifiers 1

IdentifierTypeStateIssuer
36889270MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070501000428 CO Practitioner - Nurse Practitioner 6305942780 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of New Mexico School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pueblo Community Health Center Inc.Group PAC ID 4284543802, 66 clinicians

Practice addresses (Care Compare)

300 Colorado Ave
Pueblo, CO 81004-2006
Phone (719) 543-8711

Hospital & facility affiliations

  • St Mary-Corwin Hospital Hospital, Pueblo, CO, CCN 060012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
100124COMDNurse Practitioner

Practice roles (5 of 8)

OrganizationSpecialtyStatusNew patients
Pueblo Community Health Center Inc CurrentSince Sep 16, 2017 Accepting new patients
Pueblo Community Health Center Inc CurrentSince Sep 16, 2017 Accepting new patients
Rocky Mountain Cancer Centers LLP Nurse Practitioner CurrentSince Jul 27, 2013 Accepting new patients
Rocky Mountain Cancer Centers, LLP CurrentSince Jul 27, 2013 Accepting new patients
Pueblo Community Health Center Inc. Past Accepting new patients

Locations

3027 N Circle Dr
Colorado Springs, CO 80909
Phone (719) 577-2555

110 E Routt Ave
Pueblo, CO 81004
Phone (719) 543-8718

300 Colorado Ave
Pueblo, CO 81004
Phone (719) 543-8718

Networks

  • CO HMO
  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
  • CO HMO D-SNP

Interoperability endpoints

  • Direct secure messaging: lynne.evetts.p1@direct.pueblochc.nextgenshare.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1023054541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E ROUTT AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042117",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COLORADO AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042006",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVETTS",
        "first_name": "LYNNE",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "100124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36889270",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.