Provider Demographics
NPI:1487858346
Name:MISTRY, KELLY ELIZABETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:MISTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:SIBRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2637 MIDPOINT DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4408
Mailing Address - Country:US
Mailing Address - Phone:970-488-1666
Mailing Address - Fax:
Practice Address - Street 1:2637 MIDPOINT DR STE B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4408
Practice Address - Country:US
Practice Address - Phone:434-243-4394
Practice Address - Fax:434-243-4873
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244716208M00000X
CODR.0049829208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist