Provider Demographics
NPI:1285112946
Name:HOUNTRAS, STACY COLVARD (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:COLVARD
Last Name:HOUNTRAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3540
Mailing Address - Country:US
Mailing Address - Phone:303-296-1767
Mailing Address - Fax:303-296-3484
Practice Address - Street 1:3800 N YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3540
Practice Address - Country:US
Practice Address - Phone:303-296-1767
Practice Address - Fax:303-296-3484
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0993974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0993974OtherCOLORADO DEPARTMENT OF REGULATORY LICENSE