Provider Demographics
NPI:1477204758
Name:DONALDSON, JESSICA L (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19593 LINDENMERE DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-3497
Mailing Address - Country:US
Mailing Address - Phone:206-941-4053
Mailing Address - Fax:
Practice Address - Street 1:6965 TUTT BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3596
Practice Address - Country:US
Practice Address - Phone:719-266-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997257-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics