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General NPI Number Information
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NPI Number | 1790012029
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Entity Type | Individual
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Provider Name | JORDAN MICHELLE GOUGH PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 950 S CHERRY ST STE 1675
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City | DENVER
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State | CO
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Zip | 80246-2532
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Country | US
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Telephone | 303-558-6592
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Fax | 720-637-6635
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Provider Business Mailing Address
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Address Line | 950 S CHERRY ST STE 1675
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City | DENVER
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State | CO
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Zip | 80246-2532
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Country | US
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Telephone | 303-558-6592
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Fax | 720-637-6635
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0999061-NP
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License Number State | CO
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