MEDICARE: JENNIFER GAUGHAN MS, APRN, CPNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	0182070	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700201589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GAUGHAN MS, APRN, CPNP-PC

Provider Business Mailing Address
First Line	:	3540 S POPLAR ST STE 202
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-1362
Country	:	US
Telephone Number	:	720-442-3615
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 S POPLAR ST STE 202
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-1362
Country	:	US
Telephone Number	:	720-442-3615
Fax Number	:	720-870-3726

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

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	02/03/2021

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