Healthcare Provider Details

I. General information

NPI: 1558850651
Provider Name (Legal Business Name): JOHN RYAN MCINERNEY DNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BARNES RD STE 245
COLORADO SPRINGS CO
80917-1564
US

IV. Provider business mailing address

4440 BARNES RD STE 245
COLORADO SPRINGS CO
80917-1564
US

V. Phone/Fax

Practice location:
  • Phone: 719-600-9455
  • Fax: 719-960-3002
Mailing address:
  • Phone: 719-600-9455
  • Fax: 719-960-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0999768-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.1696573
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: