Provider Demographics
NPI:1598110280
Name:EDEN, KELLEY (ND)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:EDEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:BENWARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:826 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-1320
Mailing Address - Country:US
Mailing Address - Phone:719-680-0605
Mailing Address - Fax:
Practice Address - Street 1:135 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2763
Practice Address - Country:US
Practice Address - Phone:719-680-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1240175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath