Healthcare Provider Details

I. General information

NPI: 1255986741
Provider Name (Legal Business Name): JENNIFER FLICKINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N CASCADE AVE STE 301
COLORADO SPRINGS CO
80907-6265
US

IV. Provider business mailing address

2920 N CASCADE AVE STE 301
COLORADO SPRINGS CO
80907-6265
US

V. Phone/Fax

Practice location:
  • Phone: 719-636-1201
  • Fax: 719-636-1326
Mailing address:
  • Phone: 719-636-1201
  • Fax: 719-636-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberAPN.0994914-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberAPRN.CNP.024577
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberAPN.0994914-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0994914-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994914-NP
License Number StateCO
# 6
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN0994914-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: