Provider Demographics
NPI:1306263181
Name:KOURY, SHAWN A (NP-C)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:A
Last Name:KOURY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:A
Other - Last Name:KOURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1104 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2826
Mailing Address - Country:US
Mailing Address - Phone:719-298-4430
Mailing Address - Fax:
Practice Address - Street 1:1104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2826
Practice Address - Country:US
Practice Address - Phone:719-298-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991118-NP363LF0000X, 363L00000X
CO0101601-NP363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23634073Medicaid
CO23634073Medicaid