Provider Demographics
NPI:1922459973
Name:NOONAN, KELLY (DPM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NOONAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST STE F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1833
Mailing Address - Country:US
Mailing Address - Phone:970-343-4217
Mailing Address - Fax:
Practice Address - Street 1:2001 S SHIELDS ST STE F
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1833
Practice Address - Country:US
Practice Address - Phone:970-343-4217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY169213ES0103X
MA2490213ES0103X
COPOD.0000925213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery