MEDICARE: SHELLY JOLES

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	363LF0000X	Family Nurse Practitioner	F12240290	CO
2	207QA0505X	Adult Medicine Physician	40494	CO

General Provider Information

NPI Number	:	1265249973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY JOLES

Provider Business Mailing Address
First Line	:	4450 SETON PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5209
Country	:	US
Telephone Number	:	719-205-9985
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 E WOODMEN RD STE 210
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3587
Country	:	US
Telephone Number	:	719-262-0852
Fax Number	:	719-262-0853

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	03/12/2025

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Directions to “ SHELLY JOLES ” Practice Location

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