Healthcare Provider Details

I. General information

NPI: 1619042256
Provider Name (Legal Business Name): JESSICA TRAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 61ST AVE
GREELEY CO
80634-3044
US

IV. Provider business mailing address

1709 61ST AVE
GREELEY CO
80634-3044
US

V. Phone/Fax

Practice location:
  • Phone: 970-330-0333
  • Fax: 970-330-3197
Mailing address:
  • Phone: 970-330-0333
  • Fax: 970-330-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number176379
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: