Healthcare Provider Details

I. General information

NPI: 1316799133
Provider Name (Legal Business Name): KIRRA MCKELL KENNEDY NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIRRA MCKELL DRAKE NP-BC

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 GRAND CORDERA PKWY STE 100
COLORADO SPRINGS CO
80924-7004
US

IV. Provider business mailing address

4187 DIAMOND RIDGE VW
COLORADO SPRINGS CO
80918-5639
US

V. Phone/Fax

Practice location:
  • Phone: 719-282-6337
  • Fax: 719-282-0532
Mailing address:
  • Phone: 970-396-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001574-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: