Healthcare Provider Details

I. General information

NPI: 1982958203
Provider Name (Legal Business Name): KELLY ANNE FAUSEY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 S 8TH AVE
BRIGHTON CO
80601-2132
US

IV. Provider business mailing address

183 S 18TH AVE
BRIGHTON CO
80601-2472
US

V. Phone/Fax

Practice location:
  • Phone: 303-655-8924
  • Fax: 303-200-7399
Mailing address:
  • Phone: 303-659-4248
  • Fax: 303-659-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC-ANP.0000306-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0000306
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: