Healthcare Provider Details

I. General information

NPI: 1831264480
Provider Name (Legal Business Name): KELLEY LYNNE BUNDY B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 DOWNING ST
DENVER CO
80218-1529
US

IV. Provider business mailing address

265 N DUQUESNE ST
AURORA CO
80018-4547
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-1823
  • Fax: 303-894-8107
Mailing address:
  • Phone: 720-331-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: