Healthcare Provider Details

I. General information

NPI: 1669858759
Provider Name (Legal Business Name): KELSEY LYNN YOO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E BOULDER ST STE 101
COLORADO SPRINGS CO
80909-5740
US

IV. Provider business mailing address

1725 E BOULDER ST STE 101
COLORADO SPRINGS CO
80909-5740
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6300
  • Fax: 719-365-6094
Mailing address:
  • Phone: 719-365-6300
  • Fax: 719-365-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number18906
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009849
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number018906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: