Provider Demographics
NPI:1841425782
Name:BASTIAN, KELLY SUE (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1655 GLEN MOOR PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3039
Mailing Address - Country:US
Mailing Address - Phone:720-252-8932
Mailing Address - Fax:720-482-7990
Practice Address - Street 1:6041 S SYRACUSE WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-0000
Practice Address - Country:US
Practice Address - Phone:720-482-1988
Practice Address - Fax:720-482-1990
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2015-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO111614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily