Provider Demographics
NPI:1225791148
Name:KINSMAN, JESSICA (RN-CLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KINSMAN
Suffix:
Gender:F
Credentials:RN-CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8361 TURKEY RUN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7057
Mailing Address - Country:US
Mailing Address - Phone:720-218-4110
Mailing Address - Fax:
Practice Address - Street 1:8361 TURKEY RUN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7057
Practice Address - Country:US
Practice Address - Phone:720-218-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO337310174N00000X
CO1640647163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN