Provider Demographics
NPI:1588232367
Name:LINNEBUR, KELLY B
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:B
Last Name:LINNEBUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:CO
Mailing Address - Zip Code:80821-0125
Mailing Address - Country:US
Mailing Address - Phone:719-743-2526
Mailing Address - Fax:719-743-2482
Practice Address - Street 1:326 8TH STREET
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:CO
Practice Address - Zip Code:80821-8082
Practice Address - Country:US
Practice Address - Phone:719-743-2526
Practice Address - Fax:719-743-2482
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program