NPIMap

Individual provider Active NPI

Kenneth Charles Daves Jr.

  • Family Nurse Practitioner
  • Fort Collins, CO
National Provider Identifier
1295474278
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN.0997759-NP Issued in CO
Practice address
1600 Specht Point Rd Ste 127
Fort Collins, CO 80525-4311
Phone
(970) 493-7733
NPI assigned
May 31, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN.0997759-NP CO Primary

Addresses

Primary practice location

1600 Specht Point Rd Ste 127
Fort Collins, CO 80525-4311

Mailing address

2638 Sagebrush Dr
Fort Collins, CO 80525-2458
Phone (662) 299-1982

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220928000256 CO Practitioner - Nurse Practitioner 7214313378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Clinic PCGroup PAC ID 7315914405, 18 clinicians

Practice addresses (Care Compare)

3351 Eastbrook Dr
Suite 100
Fort Collins, CO 80525-5744
Phone (970) 493-7733

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APN.0997759-NPCOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Clinic PC CurrentSince Sep 1, 2022 Accepting new patients
Nephrology Clinic PC CurrentSince Sep 1, 2022 Accepting new patients

Locations

1600 Specht Point Rd
Ste 127
Fort Collins, CO 80525

3351 Eastbrook Dr
Ste 100
Fort Collins, CO 80525

1000 Lincoln St
Fort Morgan, CO 80701
Phone (970) 542-3320

8229 W 20th St
Greeley, CO 80634

2988 Ginnala Dr
Loveland, CO 80538
Phone (970) 633-0815

620 Iris Dr
Sterling, CO 80751
Phone (970) 313-2740

Organizations & group practices 2

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1295474278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2638 SAGEBRUSH DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805252458",
            "telephone_number": "662-299-1982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SPECHT POINT RD STE 127",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254311",
            "telephone_number": "970-493-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVES",
        "first_name": "KENNETH",
        "middle_name": "CHARLES",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-31",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.0997759-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.