Provider Demographics
NPI:1659767853
Name:HOMSHER, JENNA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HOMSHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:WALSH
Mailing Address - State:CO
Mailing Address - Zip Code:81090-0608
Mailing Address - Country:US
Mailing Address - Phone:719-324-5253
Mailing Address - Fax:
Practice Address - Street 1:137 N KANSAS
Practice Address - Street 2:
Practice Address - City:WALSH
Practice Address - State:CO
Practice Address - Zip Code:81090
Practice Address - Country:US
Practice Address - Phone:719-324-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0195546163W00000X
KS14-113161-051163W00000X
KS76867363LF0000X
COAPN.0991850-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse