Provider Demographics
NPI:1255494613
Name:GLANCEY, KELLEY K (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:K
Last Name:GLANCEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80482-1312
Mailing Address - Country:US
Mailing Address - Phone:970-722-0300
Mailing Address - Fax:970-722-1032
Practice Address - Street 1:78878 US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482
Practice Address - Country:US
Practice Address - Phone:970-722-0300
Practice Address - Fax:970-722-1032
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044545207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0203552OtherLABOR AND INDUSTRIES
WA8430563Medicaid
WA8857563Medicare ID - Type Unspecified
WA8430563Medicaid