MEDICARE: JAMIE K MCCARTNEY HERBERT PMHNP-BC

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	163W00000X	Registered Nurse	RN.1635805	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0997328-NP	CO

General Provider Information

NPI Number	:	1679062855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE K MCCARTNEY HERBERT PMHNP-BC

Provider Business Mailing Address
First Line	:	320 E FONTANERO ST STE 301
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7526
Country	:	US
Telephone Number	:	719-644-6463
Fax Number	:	844-579-0123

Provider Business Practice Location Address
First Line	:	320 E FONTANERO ST STE 301
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7526
Country	:	US
Telephone Number	:	719-644-6463
Fax Number	:	844-579-0123

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

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	02/08/2022

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