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General NPI Number Information
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NPI Number | 1871151324
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Entity Type | Individual
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Provider Name | JESSICA SOUVATDY MEHRARA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 1400 JACKSON ST
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City | DENVER
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State | CO
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Zip | 80206-2762
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Country | US
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Telephone | 303-388-4461
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 E BAYAUD AVE UNIT A
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City | DENVER
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State | CO
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Zip | 80224-3836
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Country | US
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Telephone | 479-719-9215
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN.0994737-NP
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License Number State | CO
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