Organization Active NPI

Half Moon Health and Wellness, LTD.

  • Family Nurse Practitioner
  • Boulder, CO
National Provider Identifier
1174398515
Registry record updated Jul 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
HALF MOON HEALTH AND WELLNESS, LTD.
Practice address
1530 55TH St Ste 123
Boulder, CO 80303-1256
Phone
(720) 477-6699
Fax
(833) 973-4351
NPI assigned
Nov 15, 2023
Last updated
Jul 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2025

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

Authorized official

Name
Ms. Kristina R Gutzman, FNP-CNPI 1609150218
Title
Nurse Practitioner
Phone
(805) 400-7747

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

1530 55TH St Ste 123
Boulder, CO 80303-1256

Mailing address

1530 55TH St Ste 123
Boulder, CO 80303-1256
Phone (720) 477-6699

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241017001140 CO Part B Supplier - Clinic/Group Practice 3274065016 Receives reassigned benefits from 1 practitioner
Practice locations: Broomfield, CO

National Provider Directory

National Provider Directory

Locations

1530 55th St
Ste 123
Boulder, CO 80303
Phone (720) 477-6699

3400 Industrial Ln
Unit 1A
Broomfield, CO 80020
Phone (720) 477-6699

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751673600000",
    "number": "1174398515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 55TH ST STE 123",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031256",
            "telephone_number": "720-477-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 55TH ST STE 123",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031256",
            "telephone_number": "720-477-6699",
            "fax_number": "833-973-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALF MOON HEALTH AND WELLNESS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-15",
        "last_updated": "2025-07-05",
        "certification_date": "2025-07-05",
        "status": "A",
        "authorized_official_last_name": "GUTZMAN",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "805-400-7747",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.