Individual
JACOB ALLEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
615 N NEVADA AVE STE 1E, COLORADO SPRINGS, CO 80903-1075
(719) 726-1077
(719) 960-2933
Mailing address
615 N NEVADA AVE STE 1E, COLORADO SPRINGS, CO 80903-1075
(719) 726-1077
(719) 960-2933
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APN.0996156-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000191072
—
CO
Enumeration date
07/03/2020
Last updated
04/15/2026
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