Healthcare Provider Details

I. General information

NPI: 1972265791
Provider Name (Legal Business Name): KELLY KRISTOPHER MCWHIRTER DMSC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR UNIT MEDDAC
FT CARSON CO
80913
US

IV. Provider business mailing address

1650 COCHRANE CIR UNIT MEDDAC
FT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-726-7000
  • Fax:
Mailing address:
  • Phone: 719-526-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0007392
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: