Provider Demographics
NPI:1891119939
Name:FOX, KELLY (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11485 HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:ECKERT
Mailing Address - State:CO
Mailing Address - Zip Code:81418-5213
Mailing Address - Country:US
Mailing Address - Phone:720-626-3610
Mailing Address - Fax:
Practice Address - Street 1:11485 HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:ECKERT
Practice Address - State:CO
Practice Address - Zip Code:81418-5213
Practice Address - Country:US
Practice Address - Phone:720-626-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991030-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health