Provider Demographics
NPI:1770772683
Name:REISS, JESSICA (PMHNP, FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REISS
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JOY
Other - Last Name:KERSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 18611
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80402-6043
Mailing Address - Country:US
Mailing Address - Phone:303-335-7070
Mailing Address - Fax:
Practice Address - Street 1:6093 S QUEBEC ST STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4543
Practice Address - Country:US
Practice Address - Phone:303-770-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO126657363LC1500X
CO5350363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16452313Medicaid
CO023659OtherKAISER COMMERCIAL NUMBER
CO16452313Medicaid
C810750Medicare PIN
CO023659OtherKAISER COMMERCIAL NUMBER