Provider Demographics
NPI:1215134705
Name:KLAKER, JULIE M (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:M
Last Name:KLAKER
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 FLINTRIDGE DR STE 220I
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4273
Mailing Address - Country:US
Mailing Address - Phone:719-224-9080
Mailing Address - Fax:
Practice Address - Street 1:4740 FLINTRIDGE DR STE 220I
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4273
Practice Address - Country:US
Practice Address - Phone:719-224-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2019012763363LP0808X
CO164999363L00000X
CO5357-NP363LF0000X
AK1110363LF0000X
COAPN.0005357-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91158541Medicaid
CO1821667353Medicaid
CO1215134705Medicaid
CO840255530065OtherROCKY MTN HEALTH PLANS
1215134705OtherNPI
P01373091OtherRAILROAD WORKERS MEDICARE FOR BASIN CLINIC