Healthcare Provider Details

I. General information

NPI: 1871869057
Provider Name (Legal Business Name): KELLY MARIE EVANS-HULLINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY EVANS M.D.

II. Dates (important events)

Enumeration Date: 04/01/2012
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E 19TH AVE STE 520
DENVER CO
80218-1243
US

IV. Provider business mailing address

4900 S MONACO ST #210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 720-754-8134
  • Fax: 303-869-2258
Mailing address:
  • Phone: 720-754-8134
  • Fax: 303-869-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0055106
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: