1750402558 NPI number — MS. KARIN E KELLER FNP

Table of content: MS. KARIN E KELLER FNP (NPI 1750402558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750402558 NPI number — MS. KARIN E KELLER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLER
Provider First Name:
KARIN
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750402558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 TELLER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-8014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-372-0617
Provider Business Mailing Address Fax Number:
303-372-0669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 E 9TH AVE
Provider Second Line Business Practice Location Address:
B-120
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80262-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-372-0617
Provider Business Practice Location Address Fax Number:
303-372-0669
Provider Enumeration Date:
04/02/2007

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: 363LF0000X , with the licence number:  APN0002322 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2100X , with the licence number: 70200 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 70200 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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