Provider Demographics
NPI:1053955500
Name:STORMES, JENNIE (MSN APN RXN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:STORMES
Suffix:
Gender:F
Credentials:MSN APN RXN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E FONTANERO ST STE 301
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7526
Mailing Address - Country:US
Mailing Address - Phone:719-644-6463
Mailing Address - Fax:844-579-0123
Practice Address - Street 1:320 E FONTANERO ST STE 301
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7526
Practice Address - Country:US
Practice Address - Phone:719-644-6463
Practice Address - Fax:844-579-0123
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN.0104597-NP363LP0808X
CO1629851163WH0200X, 163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse