Healthcare Provider Details

I. General information

NPI: 1255785515
Provider Name (Legal Business Name): SHANNON POWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON RODRIGUEZ

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5799 STETSON HILLS BLVD
COLORADO SPRINGS CO
80917-4223
US

IV. Provider business mailing address

19246 E IDAHO PL UNIT 103
AURORA CO
80017-6360
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-2273
  • Fax: 719-380-0228
Mailing address:
  • Phone: 719-440-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0992329-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10256
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017791
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992329-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: