1962409342 NPI number — DR. KAREN KELLY M.D.

Table of content: DR. KAREN KELLY M.D. (NPI 1962409342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962409342 NPI number — DR. KAREN KELLY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLY
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELLY-HEMLER
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962409342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 COLE BLVD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
GOLDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-716-8013
Provider Business Mailing Address Fax Number:
303-763-5495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 YOUNGFIELD ST
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-2263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-898-9427
Provider Business Practice Location Address Fax Number:
303-302-0808
Provider Enumeration Date:
06/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  29388 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01293885 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".