Provider Demographics
NPI:1356693188
Name:KISSINGER, CHELSEA LAUREN (APRN)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LAUREN
Last Name:KISSINGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-360-6276
Mailing Address - Fax:303-467-5350
Practice Address - Street 1:700 POTOMAC ST STE A
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6845
Practice Address - Country:US
Practice Address - Phone:303-360-6276
Practice Address - Fax:303-360-3713
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1644965163W00000X
GARN198963363LF0000X
COAPN.0993067-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128320AMedicaid
GA003128320BMedicaid
GA003128320DMedicaid
GA003128320CMedicaid
GA20250I4882Medicare PIN