Healthcare Provider Details

I. General information

NPI: 1558993170
Provider Name (Legal Business Name): KELLY DINEEN SCOTT-KITZMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY SCOTT

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 11TH AVE
EVANS CO
80620-1011
US

IV. Provider business mailing address

2930 11TH AVE
EVANS CO
80620-1011
US

V. Phone/Fax

Practice location:
  • Phone: 970-353-9403
  • Fax: 970-353-5884
Mailing address:
  • Phone: 970-350-4606
  • Fax: 970-350-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number995343
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: