Provider Demographics
NPI:1437691896
Name:HOMRA MCDOWELL, JACQUELYN S (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:S
Last Name:HOMRA MCDOWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:S
Other - Last Name:HOMRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1400 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2761
Mailing Address - Country:US
Mailing Address - Phone:303-388-4461
Mailing Address - Fax:303-398-1211
Practice Address - Street 1:1400 JACKSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2761
Practice Address - Country:US
Practice Address - Phone:303-388-4461
Practice Address - Fax:303-270-2206
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0199215163W00000X
COAPN.0992600-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1437691896Medicaid