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NPI Code Detail

MEDICARE: MRS. JORDAN MICHELLE GOUGH PMHNP-BC

MEDICARE: MRS. JORDAN MICHELLE GOUGH 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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPN.0999061-NPCO

General Provider Information

NPI Number : 1790012029
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JORDAN MICHELLE GOUGH PMHNP-BC
Provider Business Mailing Address
First Line : 950 S CHERRY ST STE 1675
Second Line :
City : DENVER
State : CO
Zip : 80246-2532
Country : US
Telephone Number : 303-558-6592
Fax Number : 720-637-6635
Provider Business Practice Location Address
First Line : 950 S CHERRY ST STE 1675
Second Line :
City : DENVER
State : CO
Zip : 80246-2532
Country : US
Telephone Number : 303-558-6592
Fax Number : 720-637-6635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2009
Last Update Date : 01/18/2025

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