Healthcare Provider Details

I. General information

NPI: 1699917286
Provider Name (Legal Business Name): MICHELLE ELAINE KELLY-JONES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIRCLE EXEMPLA GOOD SMARATIN MEDICAL CENTER
LAFAYETTE CO
80026
US

IV. Provider business mailing address

2511 E 150TH AVE
THORNTON CO
80602-7360
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-4000
  • Fax:
Mailing address:
  • Phone: 303-451-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number168956
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: