Kaleidoscope Wellness LTD

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

KALEIDOSCOPE WELLNESS LTD

Practice address

1136 E Stuart St BLDG 4
Fort Collins, CO 80525-1195

Phone

(970) 670-0913

NPI assigned

Aug 26, 2024

Organization subpart

No

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

Authorized official

Name

Coreen Ann Brennan Herron, NPNPI 1013740273

Title

Pmhnp

Phone

(570) 772-4633

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 1

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

• Coreen Herron, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Collins, CO
  • NPI 1013740273
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1679306583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 E STUART ST BLDG 4",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805251195",
            "telephone_number": "970-670-0913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 E STUART ST BLDG 4",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805251195",
            "telephone_number": "970-670-0913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALEIDOSCOPE WELLNESS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-25",
        "status": "A",
        "authorized_official_last_name": "HERRON",
        "authorized_official_first_name": "COREEN",
        "authorized_official_middle_name": "ANN BRENNAN",
        "authorized_official_title_or_position": "PMHNP",
        "authorized_official_telephone_number": "570-772-4633",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.