Colorado State University Pueblo

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

COLORADO STATE UNIVERSITY PUEBLO

Practice address

2200 Bonforte Blvd # 172
Pueblo, CO 81001-4901

Phone

(719) 549-2830

Fax

(719) 549-2646

NPI assigned

Oct 30, 2023

Organization subpart

No

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

Authorized official

Name

Ms. Carolyn Kay Daugherty, FNP-BC

Title

Assistant Dean

Phone

(719) 549-2830

Specialties & licenses 1

Addresses

Other names 1

• Wolfpack Wellness Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carol Daugherty, NP

  • Nurse Practitioner
  • Pueblo, CO
  • NPI 1346469061
  NPD

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

{
    "created_epoch": "1698624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1467225730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 BONFORTE BLVD # 172",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810014901",
            "telephone_number": "719-549-2830",
            "fax_number": "719-549-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 BONFORTE BLVD # 172",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810014901",
            "telephone_number": "719-549-2830",
            "fax_number": "719-549-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO STATE UNIVERSITY PUEBLO",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-30",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "DAUGHERTY",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "ASSISTANT DEAN",
        "authorized_official_telephone_number": "719-549-2830",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wolfpack Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Colorado Permanente Medical Group, P.C.
• Colorado Permanente Medical Group, P.C.
• Colorado Secure Transportation, LLC
• Colorado Springs Dermatology Clinic, P.C.
• Colorado Springs Oral and Facial Surgery Center PLLC
• Colorado Treatment Services LLC
• Kristen Arielle Colvin
• Andrew Comerci, BS, MS
• Comfort Care Family Practice, Inc.
• Maren Comfort

• Family Nurse Practitioner in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Family Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.