Provider Demographics
NPI:1033351325
Name:NEELY, KELLI J (CNM)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:J
Last Name:NEELY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:3205 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5101
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:719-344-7837
Practice Address - Street 1:225 S UNION BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3184
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-344-7830
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2017-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO196714367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO280813YKRDOtherMEDICARE NUMBER
CO42888361Medicaid