Healthcare Provider Details

I. General information

NPI: 1205251865
Provider Name (Legal Business Name): KELLI DANNA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 THREE SPRINGS BLVD
DURANGO CO
81301-8296
US

IV. Provider business mailing address

296 NORTH RD
DURANGO CO
81303-6429
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-4311
  • Fax:
Mailing address:
  • Phone: 970-215-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4694
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4694
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: