Healthcare Provider Details

I. General information

NPI: 1497592323
Provider Name (Legal Business Name): JENNIFER ELLEN POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4863 N NEVADA AVE
COLORADO SPRINGS CO
80918-3951
US

IV. Provider business mailing address

4863 N NEVADA AVE
COLORADO SPRINGS CO
80918-3951
US

V. Phone/Fax

Practice location:
  • Phone: 719-255-8001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.1629671
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1000160-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: