Provider Demographics
NPI:1487838207
Name:COLBERT, KELLY J (FNP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:J
Last Name:COLBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:1600 N. GRAND AVE.
Practice Address - Street 2:STE 230
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2731
Practice Address - Country:US
Practice Address - Phone:719-595-7778
Practice Address - Fax:719-562-2097
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0005411-NP207QH0002X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16206550Medicaid
CO330960YXQFMedicare PIN