Jordan N Knickerbocker, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

PENDING Issued in CO

Practice address

3150 N 12TH St
Grand Junction, CO 81506-2863

Phone

(970) 254-2642

NPI assigned

Jul 17, 2023

Last updated

Oct 16, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jordan N Deboer Former name

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

Specialty

Nurse Practitioner

Education

University of Colorado School of Medicine, Denver, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Primary Care Partners IncGroup PAC ID 7810893161, 58 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jordanknickerbocker@pcp.allscriptsdirect.net

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.

• Primary Care Partners, Inc.

  • Family Medicine Physician
  • Grand Junction, CO
  • NPI 1245392612
  Medicare reassignment Care Compare group NPD
• Primary Care Partners, Inc.

  • Sports Medicine (Family Medicine) Physician
  • Grand Junction, CO
  • NPI 1417455403
  NPD
• Primary Care Partners, Inc.

  • Family Medicine Physician
  • Grand Junction, CO
  • NPI 1801001599
  NPD
• Primary Care Partners, Inc.

  • Pediatrics Physician
  • Grand Junction, CO
  • NPI 1326399361
  NPD (past)

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

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1811676786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10700",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815025517",
            "telephone_number": "970-254-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N 12TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815062863",
            "telephone_number": "970-254-2642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNICKERBOCKER",
        "first_name": "JORDAN",
        "middle_name": "N",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-17",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CO",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "DEBOER",
            "middle_name": "N",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelsie Kloppenberg
• Richard Alan Knackendoffel, DO
• Cody Knauss, NP
• Kathryn Knaysi, PT
• Kristen Marisol Kneebone, LCSW
• Megan Knierim
• Sandra Lee Knol
• Elizabeth Koff, MAPT
• Stephanie Kohlhofer
• Madison Kohls

• Pediatric Nurse Practitioner in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Pediatric Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.