Healthcare Provider Details

I. General information

NPI: 1659991917
Provider Name (Legal Business Name): KELSI RAE BROWN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 W 16TH ST
GREELEY CO
80634-6004
US

IV. Provider business mailing address

6801 W 20TH ST UNIT 101
GREELEY CO
80634-9640
US

V. Phone/Fax

Practice location:
  • Phone: 970-353-7668
  • Fax: 970-353-2801
Mailing address:
  • Phone: 970-378-8000
  • Fax: 970-378-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL.0008333
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0068331
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: