Healthcare Provider Details

I. General information

NPI: 1245408111
Provider Name (Legal Business Name): KELLEY G ROGERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY GRIFFITH NP

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 ARAPAHOE AVE STE 200
BOULDER CO
80302-6720
US

IV. Provider business mailing address

701 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1434
US

V. Phone/Fax

Practice location:
  • Phone: 303-447-1040
  • Fax: 303-447-2882
Mailing address:
  • Phone: 52-659-5115
  • Fax: 505-268-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN.1634529
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.0992120-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: