Provider Demographics
NPI:1194518621
Name:DUNHAM, JAELYNN NICOLE
Entity type:Individual
Prefix:
First Name:JAELYNN
Middle Name:NICOLE
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 TREK TRAIL HTS APT NO301
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4516
Mailing Address - Country:US
Mailing Address - Phone:402-770-3526
Mailing Address - Fax:
Practice Address - Street 1:2312 N NEVADA AVE STE 235
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5312
Practice Address - Country:US
Practice Address - Phone:719-776-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant