Provider Demographics
NPI:1649577669
Name:IHME, KELLY RAE MCCARTHY (BSN-BC, MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RAE MCCARTHY
Last Name:IHME
Suffix:
Gender:F
Credentials:BSN-BC, MA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RAE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 RUSKIN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2522
Mailing Address - Country:US
Mailing Address - Phone:719-572-6100
Mailing Address - Fax:
Practice Address - Street 1:2864 S CIRCLE DR
Practice Address - Street 2:DTE 1000
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4114
Practice Address - Country:US
Practice Address - Phone:719-572-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO185937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse