Basic Information
Provider Information
NPI: 1649757485
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARTMELL
FirstName: JOELYNN
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 110429
Address2:  
City: AURORA
State: CO
PostalCode: 800420429
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4125 BRIARGATE PKWY
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809207804
CountryCode: US
TelephoneNumber: 7207771234
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/24/2018
LastUpdateDate: 08/31/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/31/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XAPN.0993815-NPCOY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


Home