Individual provider Active NPI

Jordan Michelle Gough, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Denver, CO
National Provider Identifier
1790012029
Registry record updated Jan 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APN.0999061-NP Issued in CO
Practice address
950 S Cherry St Ste 1675
Denver, CO 80246-2532
Phone
(303) 558-6592
Fax
(720) 637-6635
NPI assigned
Nov 6, 2009
Last updated
Jan 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APN.0999061-NP CO Primary

Addresses

Primary practice location

950 S Cherry St Ste 1675
Denver, CO 80246-2532

Mailing address

950 S Cherry St Ste 1675
Denver, CO 80246-2532
Phone (303) 558-6592

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Mar 21, 2025 through Mar 21, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
APN.0999061-NPCOMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Conscious Psychiatry, PLLC Psychiatric/Mental Health Current Accepting new patients
Wellness Psychiatry, PLLC PastSince Dec 15, 2024 Accepting new patients

Locations

950 S Cherry St
Ste 1675
Denver, CO 80246
Phone (215) 586-3102

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737158400000",
    "number": "1790012029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 S CHERRY ST STE 1675",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802462532",
            "telephone_number": "303-558-6592",
            "fax_number": "720-637-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 S CHERRY ST STE 1675",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802462532",
            "telephone_number": "303-558-6592",
            "fax_number": "720-637-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH",
        "first_name": "JORDAN",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-06",
        "last_updated": "2025-01-18",
        "certification_date": "2025-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "APN.0999061-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.