Healthcare Provider Details

I. General information

NPI: 1811988314
Provider Name (Legal Business Name): RAECHEL N O'KELLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE STE 330
DENVER CO
80220-3930
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-4076
  • Fax: 303-320-0439
Mailing address:
  • Phone: 719-463-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42436
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: