Healthcare Provider Details

I. General information

NPI: 1629048897
Provider Name (Legal Business Name): JAN KELSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 EAGLE ROCK RD
COLORADO SPRINGS CO
80918-3906
US

IV. Provider business mailing address

1130 EAGLE ROCK RD
COLORADO SPRINGS CO
80918-3906
US

V. Phone/Fax

Practice location:
  • Phone: 719-238-0117
  • Fax: 719-268-1711
Mailing address:
  • Phone: 719-238-0117
  • Fax: 719-268-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00114259
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00114259
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: