Individual provider Active NPI

Rajani Kollikara, AAS, RN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Canon City, CO
National Provider Identifier
1104256676
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
995143 Issued in CO
Practice address
3225 Independence Rd
Canon City, CO 81212-9380
Phone
(719) 275-2351
NPI assigned
Nov 20, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN.1622076 CO
Registered Nurse 163W00000X NA.00735584 CO
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 995143 CO Primary

Addresses

Primary practice location

3225 Independence Rd
Canon City, CO 81212-9380

Mailing address

3225 Independence Rd
Canon City, CO 81212-9380
Phone (719) 275-2351

Other names 1

  • Fnu Rajani Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200630000871 CO Practitioner - Nurse Practitioner 9931521408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
West Central Mental Health Center, IncGroup PAC ID 0042102733, 16 clinicians

Practice addresses (Care Compare)

3225 Independence Rd
Canon City, CO 81212-9380
Phone (719) 275-2351

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Applied Science, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
NA.00735584COMDRegistered Nurse
RN.1622076COMDRegistered Nurse
995143COMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
West Central Mental Health Center, Inc. CurrentSince Oct 10, 2022 Accepting new patients
West Central Mental Health Center Inc. CurrentSince Oct 10, 2022 Accepting new patients
West Central Mental Health Center, Inc. Current Accepting new patients

Locations

3225 Independence Rd
Canon City, CO 81212
Phone (719) 275-2351

111 Vesta Rd
Salida, CO 81201
Phone (719) 275-2351

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1104256676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 INDEPENDENCE RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812129380",
            "telephone_number": "719-275-2351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 INDEPENDENCE RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812129380",
            "telephone_number": "719-275-2351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLIKARA",
        "first_name": "RAJANI",
        "credential": "AAS, RN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-20",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "RN.1622076",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "NA.00735584",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "995143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FNU",
            "last_name": "RAJANI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Canon City, CO

Sources for this page

Verify at the official NPI Registry.