Provider Demographics
NPI:1003936121
Name:BAILEY, KERI (CPNP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S COLORADO BLVD
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1912
Mailing Address - Country:US
Mailing Address - Phone:303-584-8000
Mailing Address - Fax:866-210-0907
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 5500
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1291
Practice Address - Country:US
Practice Address - Phone:303-839-6001
Practice Address - Fax:303-839-6033
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161119363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04901363OtherMEDICAID PRACTICE NUMBER
CO15380840Medicaid
CO37402552OtherMEDICAID PRACTICE NUMBER
CO54552826OtherMEDICAID PRACTICE NUMBER
COC809609OtherMEDICARE GROUP NUMBER
CO809609OtherMEDICARE GROUP PTAN