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NPI Code Detail

MEDICARE: JACKI SUE DEGOLYER FNP

MEDICARE: JACKI SUE DEGOLYER 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
1363LP2300XPrimary Care Nurse Practitioner5019545NC
2363LF0000XFamily Nurse Practitioner0996679-NPCO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10175594OTHERCOCOLORADO REGISTERED NURSE LICENSE
20996679-NPOTHERCOADVANCED PRACTICE NURSE
3227042OTHERCOCDE SPECIAL SERVICE PROVIDER
4364412OTHERNCREGISTERED NURSE
55019545OTHERNCADVANCED PRACTICE NURSE

General Provider Information

NPI Number : 1356912497
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKI SUE DEGOLYER FNP
Provider Business Mailing Address
First Line : 999 18TH ST STE 3000
Second Line :
City : DENVER
State : CO
Zip : 80202-2449
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 999 18TH ST STE 3000
Second Line :
City : DENVER
State : CO
Zip : 80202-2449
Country : US
Telephone Number : 888-731-8994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2021
Last Update Date : 12/15/2025

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