Provider Demographics
NPI:1679710321
Name:PHELAN, JAMIE K (RN,MSN, NNP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:K
Last Name:PHELAN
Suffix:
Gender:F
Credentials:RN,MSN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 DTC PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3052
Mailing Address - Country:US
Mailing Address - Phone:303-839-7440
Mailing Address - Fax:
Practice Address - Street 1:SKY RIDGE MEDICAL CENTER
Practice Address - Street 2:10101 RIDGEGATE PARKWAY
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:720-225-2200
Practice Address - Fax:720-225-2269
Is Sole Proprietor?:No
Enumeration Date:2009-01-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71062163WN0002X
KS5375036111363LN0000X
CORN0071062363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1679710321Medicaid