Healthcare Provider Details

I. General information

NPI: 1215087499
Provider Name (Legal Business Name): KELLY A. C. BUSBY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S WASHINGTON ST
CORTEZ CO
81321-3738
US

IV. Provider business mailing address

28 S WASHINGTON ST
CORTEZ CO
81321-3738
US

V. Phone/Fax

Practice location:
  • Phone: 970-715-1080
  • Fax: 970-638-2401
Mailing address:
  • Phone: 970-715-1080
  • Fax: 970-638-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42863
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number42863
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: