Provider Demographics
NPI:1508595059
Name:BUNDY, KELSEY L (DNP- CNM)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:BUNDY
Suffix:
Gender:F
Credentials:DNP- CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 LADY MOON DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4426
Mailing Address - Country:US
Mailing Address - Phone:970-821-4500
Mailing Address - Fax:
Practice Address - Street 1:4700 LADY MOON DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-4426
Practice Address - Country:US
Practice Address - Phone:970-821-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0100866-C-CNM176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife