Healthcare Provider Details

I. General information

NPI: 1851078737
Provider Name (Legal Business Name): KELLY JADE KLYM DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7645 RICKSHAW DR
COLORADO SPRINGS CO
80920-4010
US

IV. Provider business mailing address

7645 RICKSHAW DR
COLORADO SPRINGS CO
80920-4010
US

V. Phone/Fax

Practice location:
  • Phone: 443-681-0563
  • Fax:
Mailing address:
  • Phone: 443-681-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2022089754
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022089754
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: