Healthcare Provider Details

I. General information

NPI: 1811714454
Provider Name (Legal Business Name): KELSEY LEE BENJAMIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S FRONTAGE RD W STE 5800
VAIL CO
81657-5038
US

IV. Provider business mailing address

PO BOX 4330
EDWARDS CO
81632-4330
US

V. Phone/Fax

Practice location:
  • Phone: 970-926-6340
  • Fax: 970-926-6348
Mailing address:
  • Phone: 970-926-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1002129-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: