Healthcare Provider Details

I. General information

NPI: 1174909618
Provider Name (Legal Business Name): JESSICA FYNBOH MS, PMHNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JESSICA LYNN SWAGER

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 03/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10465 MELODY DR STE 226
NORTHGLENN CO
80234
US

IV. Provider business mailing address

10465 MELODY DR STE 226
NORTHGLENN CO
80234-4120
US

V. Phone/Fax

Practice location:
  • Phone: 720-331-6899
  • Fax: 720-306-5499
Mailing address:
  • Phone: 720-331-6899
  • Fax: 720-306-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRXN.0101875-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0992275-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: