MEDICARE: MR. HENRY B FAGNANT PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0997689-NP	CO

General Provider Information

NPI Number	:	1144811746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HENRY B FAGNANT PMHNP-BC

Provider Business Mailing Address
First Line	:	4155 E JEWELL AVE STE 600
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4510
Country	:	US
Telephone Number	:	720-310-2773
Fax Number	:

Provider Business Practice Location Address
First Line	:	5931 MIDDLEFIELD RD STE 103
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-2865
Country	:	US
Telephone Number	:	720-503-1403
Fax Number	:	720-991-1349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	11/10/2025

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