Provider Demographics
NPI:1174909618
Name:FYNBOH, JESSICA (MS, PMHNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FYNBOH
Suffix:
Gender:F
Credentials:MS, PMHNP-BC, APRN
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:SWAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10465 MELODY DR STE 226
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4120
Mailing Address - Country:US
Mailing Address - Phone:720-331-6899
Mailing Address - Fax:720-306-5499
Practice Address - Street 1:10465 MELODY DR STE 226
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234
Practice Address - Country:US
Practice Address - Phone:720-331-6899
Practice Address - Fax:720-306-5499
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN.0101875-NP363LP0808X
COAPN.0992275-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1174909618OtherNPI
CO1174909618Medicaid