NICHOLAS D. CRALL (NPI# 1316262645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316262645 |
| Entity Type | Individual |
| Full Name | NICHOLAS D. CRALL |
| Credential | D.O. |
| Practice Address |
711 Barnes Ave La Junta CO 81050-2138 |
| Mailing Address |
605 Skyline Dr Fort Collins CO 80521-3326 |
| Practice Telephone | 7193845446 |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2020-06-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Q1384 | TX | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
0102203754 | VA | Allopathic & Osteopathic Physicians |
| N | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
Q1384 | TX | Allopathic & Osteopathic Physicians |
| Y | 2084B0040X |
Psychiatry & Neurology Specialization: Behavioral Neurology & Neuropsychiatry |
Q1384 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | VIRGINIA LICENSE | 0102203754 | 01 |
| TX | TEXAS LICENSE | Q1384 | 01 |
| CO | COLORADO LICENSE | DR.0063859 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 107 Woodbine Pl, Longview, TX 756012912 | 4803031919 |
| Street Address |
711 BARNES AVE |
| City | LA JUNTA |
| State | CO |
| Zip Code | 81050-2138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417945254 | Southeast Mental Health Services | Clinic/Center | 711 Barnes Ave, La Junta, CO 81050-2138 | 2005-10-06 |
| 1205446010 | Briana Christina Lynn | Social Worker | 711 Barnes Ave, La Junta, CO 81050-2138 | 2020-08-06 |
| 1841811254 | Brianne Dickinson | Registered Nurse | 711 Barnes Ave, La Junta, CO 81050-2138 | 2020-04-27 |
| 1306467717 | Angelique Chavez | Registered Nurse | 711 Barnes Ave, La Junta, CO 81050-2138 | 2020-04-27 |
| 1295366177 | Southeast Mental Health Services | Clinic/Center | 711 Barnes Ave, La Junta, CO 81050-2138 | 2020-01-30 |
| 1477195170 | Jonathon Michael Melendez | Counselor | 711 Barnes Ave, La Junta, CO 81050-2138 | 2019-10-14 |
| 1245880848 | Martin Valdez | Case Manager/Care Coordinator | 711 Barnes Ave, La Junta, CO 81050-2138 | 2019-09-16 |
| 1528611712 | Shana Se'rae Santistevan | Registered Nurse | 711 Barnes Ave, La Junta, CO 81050-2138 | 2019-07-17 |
| 1538624523 | Richard Keck | Case Manager/Care Coordinator | 711 Barnes Ave, La Junta, CO 81050-2138 | 2019-02-05 |
| 1396218475 | Austin Coy | Case Manager/Care Coordinator | 711 Barnes Ave, La Junta, CO 81050-2138 | 2019-01-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225658057 | Poudre Valley Medical Group, LLC | Internal Medicine | 2315 San Juan Avenue, La Junta, CO 81050 | 2020-04-22 |
| 1316589567 | Southeast Mental Health Services | Clinic/Center | 721 Barnes Ave, La Junta, CO 81050 | 2019-10-09 |
| 1164945127 | Susan Ann Workman | Clinical Nurse Specialist | 13 West Third Street, Room 111, La Junta, CO 81050 | 2017-07-21 |
| 1952774465 | Ryan T Anderson Ddc PC | Clinic/Center | 13 E 4th St., La Junta, CO 81050 | 2015-11-05 |
| 1083086524 | Ryan Taylor Anderson | Dentist | 13 East 4th Street, La Junta, CO 81050 | 2015-10-23 |
| 1902287329 | Shanna Kay Riley | Case Manager/Care Coordinator | 711 Barnes Ave., La Junta, CO 81050 | 2015-06-11 |
| 1548668593 | Joseph Wayne Lee | Licensed Practical Nurse | 1203 Holt Ln, Lajunta, CO 81050 | 2014-12-08 |
| 1730506809 | Down To Earth Dentistry, LLC. | Dentist | 17 W. 4th St., La Junta, CO 81050 | 2014-03-26 |
| 1154668275 | Arkansas Valley Hearing Center, Inc | Hearing Aid Equipment | 408 West 3rd St, La Junta, CO 81050 | 2013-01-09 |
| 1710223698 | Timothy Eugene Kelley | Counselor | 313 West Third Street, Suite 204, La Junta, CO 81050 | 2012-12-20 |
| Find all providers in zip 81050 | ||||
| Taxonomy Code | 2084B0040X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Behavioral Neurology & Neuropsychiatry |
| Behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues. |
| Notes: Source: National Uniform Claim Committee. [1/1/2012: new] Additional Resources: American Academy of Neurology, www.aan.com. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669098778 | Chriesl Infusion Centers LLC | Psychiatry & Neurology | 1444 S Potomac St Ste 220, Aurora, CO 80012-4509 | 2020-06-24 |
| 1366861353 | Isaiah Kletenik | Psychiatry & Neurology | 12605 E 16th Ave, Aurora, CO 80045-2545 | 2014-04-08 |
| 1659537199 | Peter Scott Pressman | Psychiatry & Neurology | 12605 E 16th Ave, University of Colorado Hospital, Aurora, CO 80045-2545 | 2008-08-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.