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General NPI Number Information
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NPI Number | 1356912497
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Entity Type | Individual
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Provider Name | JACKI SUE DEGOLYER FNP
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Gender | Female
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 999 18TH ST STE 3000
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City | DENVER
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State | CO
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Zip | 80202-2449
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 999 18TH ST STE 3000
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City | DENVER
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State | CO
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Zip | 80202-2449
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 5019545
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0996679-NP
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License Number State | CO
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