Provider Demographics
NPI:1598316556
Name:ABBEY, JENNIFER D
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:ABBEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 MESA RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1533
Mailing Address - Country:US
Mailing Address - Phone:719-471-2273
Mailing Address - Fax:
Practice Address - Street 1:6908 MESA RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1533
Practice Address - Country:US
Practice Address - Phone:970-290-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994970-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily