Healthcare Provider Details

I. General information

NPI: 1225371131
Provider Name (Legal Business Name): KELLY ANNE CESARY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ANNE WHITE APN

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S PAGOSA BLVD
PAGOSA SPRINGS CO
81147-8329
US

IV. Provider business mailing address

1825 N MARION ST
DENVER CO
80218-1122
US

V. Phone/Fax

Practice location:
  • Phone: 970-507-4000
  • Fax: 970-731-1988
Mailing address:
  • Phone: 303-318-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP0990563
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number166191
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: