Healthcare Provider Details

I. General information

NPI: 1366055022
Provider Name (Legal Business Name): KELLY VIRGINIA TROUTMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 S 5TH ST
MONTROSE CO
81401-5716
US

IV. Provider business mailing address

516 SPRING CREEK RD
MONTROSE CO
81403-3326
US

V. Phone/Fax

Practice location:
  • Phone: 907-249-2421
  • Fax:
Mailing address:
  • Phone: 240-422-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRXN.0106140
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0996994-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1056125
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1670863
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: