Provider Demographics
NPI:1558621805
Name:BISHARD, KALEY (PMHNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:
Last Name:BISHARD
Suffix:
Gender:F
Credentials:PMHNP-BC, RN
Other - Prefix:
Other - First Name:KALEY
Other - Middle Name:
Other - Last Name:FORNELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC, RN
Mailing Address - Street 1:4856 INNOVATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5540
Mailing Address - Country:US
Mailing Address - Phone:970-494-4200
Mailing Address - Fax:970-613-4475
Practice Address - Street 1:700 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1842
Practice Address - Country:US
Practice Address - Phone:970-494-4200
Practice Address - Fax:970-399-8037
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-RXN.0001087-C-NP163W00000X
CORN-204924163W00000X
IN28186184A163W00000X
CO0990416363LP0808X
COC-APN.0002416-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse