Provider Demographics
NPI:1689736761
Name:ADAMSON, KELLI DAWN (RN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:DAWN
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:RN
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 38
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE WELLS
Mailing Address - State:CO
Mailing Address - Zip Code:80810-0038
Mailing Address - Country:US
Mailing Address - Phone:719-767-5616
Mailing Address - Fax:719-767-8747
Practice Address - Street 1:615 W 5 N
Practice Address - Street 2:
Practice Address - City:CHEYENNE WELLS
Practice Address - State:CO
Practice Address - Zip Code:80810
Practice Address - Country:US
Practice Address - Phone:719-767-5616
Practice Address - Fax:719-767-8747
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO173531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97405043Medicaid