Healthcare Provider Details

I. General information

NPI: 1841667730
Provider Name (Legal Business Name): JESSICA ROSE SKOMP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E JOHNSON ST
HOLYOKE CO
80734-1854
US

IV. Provider business mailing address

73698 314 AVE
LAMAR NE
69023-2037
US

V. Phone/Fax

Practice location:
  • Phone: 970-854-2500
  • Fax:
Mailing address:
  • Phone: 308-883-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0000403-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: