=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093147704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY R KURZEJEWSKI CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2013
-----------------------------------------------------
Last Update Date | 08/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 E BOULDER ST STE 101
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80909-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-365-6300
-----------------------------------------------------
Fax | 719-365-5238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-365-6300
-----------------------------------------------------
Fax | 719-365-5238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | SP013625
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 23349
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 0024178726
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | C-APN.0002601-C-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------