SOUTHERN COLORADO DERMATOLOGY CLINIC PC (NPI# 1548409139) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548409139 |
| Entity Type | Organization |
| Organization Name | SOUTHERN COLORADO DERMATOLOGY CLINIC PC |
| Practice Address |
2001 Lake Ave Pueblo CO 81004-3538 |
| Practice Telephone | 7195645544 |
| Mailing Telephone | 7195645544 |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2012-05-16 |
| Authorized Official Name | KRYSTAL JEAN NAKAMURA (OWNER) |
| Authorized Official Telephone | 7195645544 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 44146 | CO | Allopathic & Osteopathic Physicians |
| Street Address |
2001 LAKE AVE |
| City | PUEBLO |
| State | CO |
| Zip Code | 81004-3538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669442422 | Krystal J Holderness Nakamura | Dermatology | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2006-01-25 |
| 1922351279 | Infectious Disease Specialist of Southern Colorado, Pllc | Clinic/Center | 2001 Lake Ave, Suite 2, Pueblo, CO 81004-3538 | 2012-10-24 |
| 1497912851 | Larry D Walls Md Prof LLC | Internal Medicine | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2008-05-21 |
| 1558528919 | Kyra Hootman Do PC | Internal Medicine | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2008-05-21 |
| 1003012279 | Melchor Sipalay Md LLC | Internal Medicine | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2007-06-25 |
| 1437108131 | Kyra K Hootman | Internal Medicine | 2001 Lake Ave, Pueblo, CO 81004-3535 | 2006-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780155929 | Renee C Lane | Nurse Practitioner | 1925 E. Orman Ave. Ste. A109, Pueblo, CO 81004 | 2018-12-16 |
| 1215406913 | Kaiser Foundation Healthplan of Colorado | Pharmacy | 2625 W. Pueblo Blvd, Pueblo, CO 81004 | 2018-11-26 |
| 1053895532 | Rebecka Ann Reatherford | Nurse Practitioner | St Mary-corwin Medical Center, 1008 Minnequa Ave, Pueblo, CO 81004 | 2018-09-20 |
| 1124510821 | Angela M Sillas-green | Counselor | 327 Colorado Ave., Pueblo, CO 81004 | 2018-05-30 |
| 1558898569 | Alexandra R B King | Family Medicine | Southern Colorado Family Medicine, 902 Lakeview Avenue, Pueblo, CO 81004 | 2017-05-22 |
| 1578098752 | James Williams | Counselor | 414 Broadway Ave, Pueblo, CO 81004 | 2017-04-26 |
| 1740732601 | Valerie A Senger | Counselor | 635 W Corona Ave Ste 214, Pueblo, CO 81004 | 2016-10-26 |
| 1194111500 | A New Leaf Therapy, Pllc | Community/Behavioral Health | 327 Colorado Ave, Pueblo, CO 81004 | 2015-04-13 |
| 1619371671 | Mariah Mcginnis | Registered Nurse | 1232 Van Buren St., Pueblo, CO 81004 | 2014-10-20 |
| 1730593112 | Maritza Martinez | Registered Nurse | 1026 Wabriendo Ave, Pueblo, CO 81004 | 2014-06-13 |
| Find all providers in zip 81004 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942324751 | Judith L. Mcguinn | Dermatology | 1600 W. 24th Street, Pueblo, CO 81003 | 2007-03-19 |
| 1669442422 | Krystal J Holderness Nakamura | Dermatology | 2001 Lake Ave, Pueblo, CO 81004-3538 | 2006-01-25 |
| 1164414801 | Sharon Marrs Kessler | Dermatology | 131 Colorado Ave, Pueblo, CO 81004-4213 | 2005-08-18 |
| 1306846746 | John Joseph Schmidt | Dermatology | 509 W 17th St, Pueblo, CO 81003-2622 | 2005-07-28 |
| 1386241453 | Colorado Springs Dermatology Clinic, P.C. | Dermatology | 406 N Main St, Pueblo, CO 81003-3123 | 2020-10-02 |
| 1821401407 | Tamar Hajar | Dermatology | 5700 N Elizabeth St, Pueblo, CO 81008-2166 | 2014-06-11 |
| 1497728786 | Kim K Dernovsek | Dermatology | 1925 E Orman Ave, Ste 115, Pueblo, CO 81004-3537 | 2006-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720685894 | Colorado Springs Dermatology Clinic, P.C. | Dermatology | 1332 Bauer Ln, Canon City, CO 81212-4669 | 2020-10-02 |
| 1891392973 | Colorado Springs Dermatology Clinic, P.C. | Dermatology | 2060 Briargate Pkwy Ste 150, Colorado Springs, CO 80920-7660 | 2020-10-02 |
| 1033723465 | Inspired Dermatology, Pllc | Dermatology | 6050 Greenwood Plaza Blvd Ste 130, Greenwood Village, CO 80111-4823 | 2020-09-02 |
| 1700496668 | Sorkin Dermatology Associates Professional LLC | Dermatology | 1960 N. Ogden Street, Suite 555, Denver, CO 80218-3602 | 2020-08-05 |
| 1194340802 | Epiphany Dermatology of Colorado, LLC | Dermatology | 2530 N 8th St Ste 205, Grand Junction, CO 81501-8858 | 2020-06-09 |
| 1861026189 | University Physicians Incorporated | Dermatology | 14305 E Alameda Ave Ste 225, Aurora, CO 80012-2549 | 2020-02-25 |
| 1316577323 | Medical Man Cave Pllc | Dermatology | 250 Steele Street, Suite 350, Denver, CO 80206-5242 | 2020-01-17 |
| 1124664248 | Allison Marquis | Dermatology | 4350 Limelight Ave Ste 205, Castle Rock, CO 80109-8034 | 2019-11-24 |
| 1790255313 | Core Dermatology, Pllc | Dermatology | 425 South Cherry Suite 907, Glendale, CO 80246 | 2018-11-26 |
| 1326521576 | Kaitlyn Laurel Pell | Dermatology | 125 Inverness Dr E Ste 340, Englewood, CO 80112-5139 | 2018-09-13 |
| Find all providers with the same taxonomy | ||||
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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.