MEDICARE: DR. JOHN RYAN MCINERNEY DNP, RN

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.0999768-NP	CO
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN.1696573	CO

General Provider Information

NPI Number	:	1558850651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RYAN MCINERNEY DNP, RN

Provider Business Mailing Address
First Line	:	4440 BARNES RD STE 245
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1564
Country	:	US
Telephone Number	:	719-600-9455
Fax Number	:	719-960-3002

Provider Business Practice Location Address
First Line	:	4440 BARNES RD STE 245
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1564
Country	:	US
Telephone Number	:	719-600-9455
Fax Number	:	719-960-3002

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

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	12/02/2025

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