Healthcare Provider Details

I. General information

NPI: 1316752074
Provider Name (Legal Business Name): JON-MIKEL OGBURN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

IV. Provider business mailing address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-2273
  • Fax:
Mailing address:
  • Phone: 970-298-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAPN.1000517-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: