Provider Demographics
NPI:1679043319
Name:MAMULA, JESSICA LAUREN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:MAMULA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4419 CENTENNIAL BLVD UNIT 506
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3739
Mailing Address - Country:US
Mailing Address - Phone:719-900-2481
Mailing Address - Fax:719-900-2483
Practice Address - Street 1:3060 N ACADEMY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5349
Practice Address - Country:US
Practice Address - Phone:719-900-2481
Practice Address - Fax:719-900-2483
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999571-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health