=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952940439
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. JILL KATHLEEN BOATWRIGHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2019
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4803 BOARDWALK DR STE 120
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-3798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-387-6883
-----------------------------------------------------
Fax | 888-965-4615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4803 BOARDWALK DR STE 120
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-3798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-387-6883
-----------------------------------------------------
Fax | 888-965-4615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 55971
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 0998162
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------