Provider Demographics
NPI:1083313639
Name:KLEIN, JESICA RAE (AGNPPC-C)
Entity Type:Individual
Prefix:
First Name:JESICA
Middle Name:RAE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:AGNPPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 LEO LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4865
Mailing Address - Country:US
Mailing Address - Phone:303-435-9615
Mailing Address - Fax:
Practice Address - Street 1:5822 S LOWELL WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2849
Practice Address - Country:US
Practice Address - Phone:206-693-4707
Practice Address - Fax:720-669-3480
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998467-NP363LG0600X, 363LP2300X, 363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health