Healthcare Provider Details

I. General information

NPI: 1306790951
Provider Name (Legal Business Name): TRAVIS AUSTIN KELLY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 ARAPAHOE AVE
BOULDER CO
80303-1200
US

IV. Provider business mailing address

9029 S YOSEMITE ST UNIT 2302
LONE TREE CO
80124-2962
US

V. Phone/Fax

Practice location:
  • Phone: 303-544-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: