Individual provider Active NPI

Kristina Renee Gutzman, FNP-C

  • Primary Care Nurse Practitioner
  • Boulder, CO
National Provider Identifier
1609150218
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
0996848-NP Issued in CO
Practice address
1530 55TH St Ste 123
Boulder, CO 80303-1256
Phone
(720) 477-6699
Fax
(833) 973-4351
NPI assigned
Sep 30, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 0996848-NP CO Primary
Acute Care Nurse Practitioner 363LA2100X 0106889 CO
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 0996848-NP CO

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

Other identifiers 1

IdentifierTypeStateIssuer
1174398515OtherCONPI GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, CO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210825001563 CA Practitioner - Nurse Practitioner 0446655740 Reassigns benefits to 1 organization
I20241017001368 CO Practitioner - Nurse Practitioner 0446655740 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0106889COMDAcute Care Nurse Practitioner
0996848-NPCOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Half Moon Health and Wellness, LTD. Single Specialty CurrentSince Sep 1, 2024 Accepting new patients
Mogo Urgent Care Single Specialty CurrentSince Jul 22, 2021 Accepting new patients

Locations

2020 Del Monte Ave
Ste B
Monterey, CA 93940
Phone (831) 622-6930

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

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

Interoperability endpoints

  • Direct secure messaging: kristina.gutzman.1@31366.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1609150218",
    "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",
            "fax_number": "833-973-4351"
        },
        {
            "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": {
        "last_name": "GUTZMAN",
        "first_name": "KRISTINA",
        "middle_name": "RENEE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-30",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CO",
            "license": "0996848-NP",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CO",
            "license": "0106889",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "0996848-NP",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP",
            "identifier": "1174398515",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.