MEDICARE: SHANNON POWELL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0992329-NP	CO
2	363LF0000X	Family Nurse Practitioner	10256	CT
3	363LF0000X	Family Nurse Practitioner	3017791	KY
4	363LF0000X	Family Nurse Practitioner	APN.0992329-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255785515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON POWELL FNP

Provider Business Mailing Address
First Line	:	19246 E IDAHO PL
Second Line	:	UNIT 103
City	:	AURORA
State	:	CO
Zip	:	80017-6360
Country	:	US
Telephone Number	:	719-440-4148
Fax Number	:

Provider Business Practice Location Address
First Line	:	5799 STETSON HILLS BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-4223
Country	:	US
Telephone Number	:	719-471-2273
Fax Number	:	719-380-0228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	03/21/2026

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Directions to “ SHANNON POWELL FNP” Practice Location

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