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NPI Code Detail

MEDICARE: JAELYNN NICOLE DUNHAM

MEDICARE: JAELYNN NICOLE DUNHAM
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
1363AS0400XSurgical Physician AssistantPA.0009251CO

General Provider Information

NPI Number : 1194518621
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAELYNN NICOLE DUNHAM
Provider Business Mailing Address
First Line : 1120 TREK TRAIL HTS APT NO301
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-4516
Country : US
Telephone Number : 402-770-3526
Fax Number :
Provider Business Practice Location Address
First Line : 2312 N NEVADA AVE STE 235
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-5312
Country : US
Telephone Number : 719-776-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2025
Last Update Date : 06/24/2025

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Directions to “ JAELYNN NICOLE DUNHAM ” Practice Location

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