Healthcare Provider Details

I. General information

NPI: 1093447435
Provider Name (Legal Business Name): JULIET JOY GLASS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25991 FERN GULCH RD
EVERGREEN CO
80439-5617
US

IV. Provider business mailing address

25991 FERN GULCH RD
EVERGREEN CO
80439-5617
US

V. Phone/Fax

Practice location:
  • Phone: 719-726-3403
  • Fax: 720-362-2968
Mailing address:
  • Phone: 719-726-3403
  • Fax: 720-362-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0997674-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: