Provider Demographics
NPI:1033542345
Name:KELNER, JESSICA (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:KELNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 RALEIGH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1374
Mailing Address - Country:US
Mailing Address - Phone:720-370-9559
Mailing Address - Fax:
Practice Address - Street 1:1525 RALEIGH ST STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:720-370-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25746207Q00000X
WV3301207Q00000X
AZ007690207Q00000X
NH18918207Q00000X
CODR.00581232081N0008X
FLOS12303207Q00000X
COCDRH.0058123207Q00000X
WI23-321207Q00000X
IL036145976207Q00000X
MN63752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine