Basic Information
| Provider Information | |||||||||
| NPI: | 1265188775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLICKINGER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, APN - PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4351 E BAILS PL | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033963268 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8565 POPLAR WAY | ||||||||
| Address2: | |||||||||
| City: | HIGHLANDS RANCH | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801303602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203482800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2022 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 1651139 | CO | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | APN.0997383-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.