Provider Demographics
NPI:1295338150
Name:KELLEY, KAYLEE NICHOLE (FNP)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:NICHOLE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:NICHOLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5965 FIRESTONE BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6607
Mailing Address - Country:US
Mailing Address - Phone:720-652-7055
Mailing Address - Fax:720-652-7056
Practice Address - Street 1:5965 FIRESTONE BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6607
Practice Address - Country:US
Practice Address - Phone:720-652-7055
Practice Address - Fax:720-652-7056
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1676466163W00000X
COAPN.0997356-NP363L00000X, 363LF0000X
PASP022812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner