Healthcare Provider Details

I. General information

NPI: 1538408729
Provider Name (Legal Business Name): KELLY LYNN SANDBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY LYNN RIVERA NP

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 GARDEN OF THE GODS RD STE 120
COLORADO SPRINGS CO
80907-3416
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-3200
  • Fax: 719-365-7680
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0990636-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: