Healthcare Provider Details

I. General information

NPI: 1952787806
Provider Name (Legal Business Name): JESSICA YOUNG APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

IV. Provider business mailing address

2750 BROADWAY ST STE 220
BOULDER CO
80304-3586
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-3082
  • Fax: 303-440-3281
Mailing address:
  • Phone: 303-440-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0106137-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number77158
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: