Healthcare Provider Details

I. General information

NPI: 1548099948
Provider Name (Legal Business Name): KELLEN CROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 09/18/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 S LINCOLN ST
DENVER CO
80210-5015
US

IV. Provider business mailing address

2340 S LINCOLN ST
DENVER CO
80210-5015
US

V. Phone/Fax

Practice location:
  • Phone: 602-513-3975
  • Fax:
Mailing address:
  • Phone: 602-513-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1651450
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1000072-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: