Provider Demographics
NPI:1790710143
Name:CALERO, KELLY R (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:R
Last Name:CALERO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-203-7520
Mailing Address - Fax:970-203-7256
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:SUITE 2200
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-203-7520
Practice Address - Fax:970-203-7256
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0004327363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98855247Medicaid
CO430555YLB8Medicare PIN