Provider Demographics
NPI:1871668335
Name:HERSH, KELLY MCKENNA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCKENNA
Last Name:HERSH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:MCKENNA
Other - Last Name:DOANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3920 FEDERAL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2274
Mailing Address - Country:US
Mailing Address - Phone:208-587-4747
Mailing Address - Fax:
Practice Address - Street 1:3920 FEDERAL BLVD STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2274
Practice Address - Country:US
Practice Address - Phone:720-858-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-5517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily