MEDICARE: MR. DONALD R KELLY P.A.

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	363AS0400X	Surgical Physician Assistant	747	CO
2	363A00000X	Physician Assistant	PA.0000747	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01052988	OTHER	CO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942269873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD R KELLY P.A.

Provider Business Mailing Address
First Line	:	2121 E HARMONY RD
Second Line	:	STE 330
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3400
Country	:	US
Telephone Number	:	970-221-5878
Fax Number	:	970-221-3564

Provider Business Practice Location Address
First Line	:	2121 E HARMONY RD
Second Line	:	STE 330
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3400
Country	:	US
Telephone Number	:	970-221-5878
Fax Number	:	970-221-3564

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	05/31/2026

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Directions to “ MR. DONALD R KELLY P.A.” Practice Location

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