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General NPI Number Information
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NPI Number | 1114535879
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Entity Type | Organization
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Legal Business Name | PIKES PEAK VISITING PROVIDERS LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/24/2022
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Provider Practice Location Address
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Address Line | 818 E CARAMILLO ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7704
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Country | US
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Telephone | 719-244-8658
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Fax |
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Provider Business Mailing Address
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Address Line | 818 E CARAMILLO ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7704
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Country | US
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Telephone | 719-459-0981
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JOCELYN REEVES
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Credential | NP-C
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Telephone | 719-459-0981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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