Healthcare Provider Details

I. General information

NPI: 1457184152
Provider Name (Legal Business Name): KELSEY MARCKSTADT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15132 E HAMPDEN AVE STE G
AURORA CO
80014-5038
US

IV. Provider business mailing address

3111 MACAULAY ST APT 306
SAN DIEGO CA
92106-1961
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-6276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.1002359-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number95198517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: