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General NPI Number Information
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NPI Number | 1225371131
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Entity Type | Individual
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Provider Name | KELLY ANNE CESARY APN
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Gender | Female
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 95 S PAGOSA BLVD
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-8329
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Country | US
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Telephone | 970-507-4000
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Fax | 970-731-1988
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Provider Business Mailing Address
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Address Line | 1825 N MARION ST
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City | DENVER
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State | CO
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Zip | 80218-1122
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Country | US
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Telephone | 303-318-3489
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 166191
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP0990563
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License Number State | CO
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