MEDICARE: DR. KELLY DIANE CROMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY.0005543	CO

General Provider Information

NPI Number	:	1508449489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY DIANE CROMER

Provider Business Mailing Address
First Line	:	18156 E BROWN PL
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-6175
Country	:	US
Telephone Number	:	305-495-6944
Fax Number	:	720-302-1017

Provider Business Practice Location Address
First Line	:	18156 E BROWN PL
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-6175
Country	:	US
Telephone Number	:	305-495-6977
Fax Number	:	720-302-1017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	06/05/2026

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