Old Colorado City Wellness PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

OLD COLORADO CITY WELLNESS PLLC

Practice address

2020 W Colorado Ave # 303
Colorado Springs, CO 80904-3882

Phone

(719) 473-2368

Fax

(719) 473-4581

NPI assigned

Sep 17, 2019

Last updated

Sep 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jill Elene Smothers, FNP, BCNPI 1912104183

Title

Owner/Managing Member

Phone

(719) 473-2368

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jill Elene Smothers, NP

  • Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1912104183
  Medicare reassignment Authorized official
• Ellen Snowden Lopez, FNP-BC

  • Family Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1609407006
  NPD (past)

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

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1154971661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W COLORADO AVE # 303",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809043882",
            "telephone_number": "719-473-2368",
            "fax_number": "719-473-4581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 W COLORADO AVE # 303",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809043882",
            "telephone_number": "719-473-2368",
            "fax_number": "719-473-4581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD COLORADO CITY WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-17",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "SMOTHERS",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "ELENE",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "719-473-2368",
        "authorized_official_credential": "FNP, BC"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modupe Mary Okonofua, PMHNP-BC, FNP-C
• Chinna Okoroafor
• Andrew Agada Okpe, MD, MRCP(UK)
• Tayanita Olavarria
• Kasey Olceski
• Rasheed Oldacre
• Olde Towne Optical and Gifts LLC
• Sherry Ann Oldenburg, M.S.
• Judith Oldendorf, RNC BSN
• Trevor Oldervik

• Family Nurse Practitioner in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Family Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.