Provider Demographics
NPI:1356770960
Name:KELLETT, JESSICA HEATHER (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HEATHER
Last Name:KELLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HEATHER
Other - Last Name:BACHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4034
Mailing Address - Fax:970-490-4347
Practice Address - Street 1:1400 E BOULDER ST STE 700
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-365-7300
Practice Address - Fax:719-365-7301
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010907363L00000X
COAPN.0994671-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner