Provider Demographics
NPI:1598867608
Name:ROSWELL, KELLEY CHARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:CHARLENE
Last Name:ROSWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:13123 E. 16TH AVENUE
Practice Address - Street 2:B251
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-724-2566
Practice Address - Fax:720-777-7317
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO439342080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47951371Medicaid
CO47951371Medicaid