Healthcare Provider Details

I. General information

NPI: 1053955500
Provider Name (Legal Business Name): JENNIE STORMES MSN APN RXN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N ACADEMY BLVD # 305
COLORADO SPRINGS CO
80918-4000
US

IV. Provider business mailing address

5225 N ACADEMY BLVD # 305
COLORADO SPRINGS CO
80918-4000
US

V. Phone/Fax

Practice location:
  • Phone: 719-644-6463
  • Fax: 844-579-0123
Mailing address:
  • Phone: 719-644-6463
  • Fax: 844-579-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1629851
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRXN.0104597-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1629851
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number1629851
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: