Healthcare Provider Details

I. General information

NPI: 1568599520
Provider Name (Legal Business Name): KIRSTY J O'DONOVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9075 FORSSTROM DR
LONETREE CO
80124-6737
US

IV. Provider business mailing address

9075 FORSSTROM DRIVE
LONE TREE CO
80124
US

V. Phone/Fax

Practice location:
  • Phone: 303-470-1995
  • Fax:
Mailing address:
  • Phone: 303-470-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33101
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: