Healthcare Provider Details

I. General information

NPI: 1619500667
Provider Name (Legal Business Name): MELISSA LYNN JONES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA KLOS NP

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 SADDLEBROOK LN
FORT COLLINS CO
80525-6966
US

IV. Provider business mailing address

1300 RIVERSIDE AVE STE 102
FORT COLLINS CO
80524-4351
US

V. Phone/Fax

Practice location:
  • Phone: 636-290-0103
  • Fax:
Mailing address:
  • Phone: 970-224-1670
  • Fax: 970-495-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995388-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: