Provider Demographics
NPI:1447896592
Name:FALLIS, JESSICA LYNN (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:FALLIS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2422
Mailing Address - Fax:970-490-4155
Practice Address - Street 1:9475 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7802
Practice Address - Country:US
Practice Address - Phone:303-470-4061
Practice Address - Fax:303-470-4062
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994751-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily