Healthcare Provider Details

I. General information

NPI: 1417012261
Provider Name (Legal Business Name): KELLY ANN PRICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 TENDERFOOT HILL RD STE 255
COLORADO SPRINGS CO
80906
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 719-576-5437
  • Fax: 719-576-5441
Mailing address:
  • Phone: 719-576-5437
  • Fax: 719-576-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0059863
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: