Healthcare Provider Details

I. General information

NPI: 1366189581
Provider Name (Legal Business Name): KELSIE BYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9197 GRANT ST
THORNTON CO
80229-4329
US

IV. Provider business mailing address

6278 UNION ST
ARVADA CO
80004-4018
US

V. Phone/Fax

Practice location:
  • Phone: 303-450-3690
  • Fax:
Mailing address:
  • Phone: 918-814-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPN.0997568-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0997568-NP
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: