Individual provider Active NPI

Adaeze Jaji

  • Psychiatric/Mental Health Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1851165054
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APN.1000862-NP Issued in CO
Practice address
805 Eagleridge Blvd Ste 140
Pueblo, CO 81008-2354
Phone
(719) 679-5022
Fax
(719) 888-1673
NPI assigned
Nov 8, 2023
Last updated
Aug 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APN.1000862-NP CO Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X RN284878 GA

Addresses

Primary practice location

805 Eagleridge Blvd Ste 140
Pueblo, CO 81008-2354

Mailing address

892 Dunlin Fields Dr
Lawrenceville, GA 30044-7812
Phone (404) 863-6462

Other practice location 1

1115 Elkton Dr Ste 300
Colorado Springs, CO 80907-3597
Phone (719) 373-9703

Other practice location 2

892 Dunlin Fields Dr
Lawrenceville, GA 30044-7812
Phone (404) 863-6462

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
I20240228000731 CO Practitioner - Nurse Practitioner 3971948100 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

805 Eagleridge Blvd
Suite 140
Pueblo, CO 81008-2354
Phone (719) 679-5022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN284878GAMDPsychiatric/Mental Health Registered Nurse

Organizations & group practices 1

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": "1699401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1851165054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "892 DUNLIN FIELDS DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447812",
            "telephone_number": "404-863-6462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 EAGLERIDGE BLVD STE 140",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082354",
            "telephone_number": "719-679-5022",
            "fax_number": "719-888-1673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1115 Elkton Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809073597",
            "country_code": "US",
            "telephone_number": "719-373-9703",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "892 Dunlin Fields Dr",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300447812",
            "country_code": "US",
            "telephone_number": "404-863-6462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAJI",
        "first_name": "ADAEZE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-08",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "APN.1000862-NP",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN284878",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.