Provider Demographics
NPI:1932440096
Name:JOHNSON, KELSEY LORRAINE (RN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LORRAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 S EMPORIA WAY
Mailing Address - Street 2:T101
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-7244
Mailing Address - Country:US
Mailing Address - Phone:951-312-5657
Mailing Address - Fax:
Practice Address - Street 1:6450 S BOSTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5336
Practice Address - Country:US
Practice Address - Phone:951-312-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0194631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0194631OtherRN LICENSE