NPIMap

Individual provider Active NPI

Alicia Hennessee, FNP, AGACNP, DNP

  • Family Nurse Practitioner
  • Erie, CO
National Provider Identifier
1174176457
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0994777 Issued in CO
Practice address
2584 Reserve St
Erie, CO 80516-2505
Phone
(720) 607-9207
Fax
(720) 738-7873
NPI assigned
Jul 16, 2019
Last updated
Dec 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 0994777 CO
Family Nurse Practitioner 363LF0000X 0994777 CO Primary

Addresses

Primary practice location

2584 Reserve St
Erie, CO 80516-2505

Mailing address

PO Box 479
Erie, CO 80516-0479
Phone (720) 607-9207

Other identifiers 1

IdentifierTypeStateIssuer
9000178345MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220622000529 CO Practitioner - Nurse Practitioner 2961881933 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Homedoc, PCGroup PAC ID 2961936927, 43 clinicians

Practice addresses (Care Compare)

2584 Reserve St
Erie, CO 80516-2505

8354 E Northfield Blvd
Suite 329
Denver, CO 80238-3131
Phone (720) 607-9207

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0994777COMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Firstdoc PC CurrentSince Aug 1, 2024 Accepting new patients
Homedoc, PC CurrentSince Sep 23, 2024 Accepting new patients
Adult Medicine Specialists PC PastSince Jan 1, 2023 Accepting new patients
Jandyco, LLC PastSince Jan 1, 2023 Accepting new patients

Locations

1690 Meade St
Denver, CO 80204
Phone (303) 264-6854

8354 E Northfield Blvd
#329
Denver, CO 80238
Phone (720) 607-9207

615 Fairhurst St
Sterling, CO 80751
Phone (970) 521-0322

6500 W 104th Ave
Westminster, CO 80020
Phone (720) 573-5000

Organizations & group practices 4

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1174176457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 479",
            "city": "ERIE",
            "state": "CO",
            "postal_code": "805160479",
            "telephone_number": "720-607-9207",
            "fax_number": "720-738-7873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2584 RESERVE ST",
            "city": "ERIE",
            "state": "CO",
            "postal_code": "805162505",
            "telephone_number": "720-607-9207",
            "fax_number": "720-738-7873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNESSEE",
        "first_name": "ALICIA",
        "credential": "FNP,  AGACNP, DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CO",
            "license": "0994777",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "0994777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000178345",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, CO

Sources for this page

Verify at the official NPI Registry.