MEDICARE: JENIELLE DAUGHERTY 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	364SF0001X	Family Health Clinical Nurse Specialist	0992438	CO

General Provider Information

NPI Number	:	1447706502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIELLE DAUGHERTY FNP

Provider Business Mailing Address
First Line	:	4100 BRIARGATE PARKWAY
Second Line	:	SUITE #300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920
Country	:	US
Telephone Number	:	719-632-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 BRIARGATE PARKWAY
Second Line	:	SUITE #300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920
Country	:	US
Telephone Number	:	719-632-7669
Fax Number	:

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

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	08/29/2016

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