Provider Demographics
NPI:1356647655
Name:SMILEY, KELLY MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:SMILEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1633 FILLMORE ST
Mailing Address - Street 2:GL-1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1514
Mailing Address - Country:US
Mailing Address - Phone:303-953-6600
Mailing Address - Fax:303-781-4333
Practice Address - Street 1:1633 FILLMORE ST
Practice Address - Street 2:GL-1
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1514
Practice Address - Country:US
Practice Address - Phone:303-953-6600
Practice Address - Fax:303-781-4333
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9236602363LF0000X
CO198216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily