Provider Demographics
NPI:1346222767
Name:MOWREY, KELLY L (RN,MS, ANP-C, CNRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:MOWREY
Suffix:
Gender:F
Credentials:RN,MS, ANP-C, CNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5693
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5693
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:7780 S BROADWAY STE 350
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2641
Practice Address - Country:US
Practice Address - Phone:720-638-7500
Practice Address - Fax:720-583-6770
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004736-NP207T00000X, 363LA2100X, 363L00000X
CO140634363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13182251Medicaid
COC811215Medicare PIN
CO13182251Medicaid