Healthcare Provider Details

I. General information

NPI: 1831829480
Provider Name (Legal Business Name): KELLY O'SHAUGHNESSY READ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9094 E MINERAL CIR STE 100
CENTENNIAL CO
80112-7201
US

IV. Provider business mailing address

9094 E MINERAL CIR STE 100
CENTENNIAL CO
80112-7201
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3200
  • Fax: 303-694-2680
Mailing address:
  • Phone: 303-694-3200
  • Fax: 303-694-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0997376-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: