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General NPI Number Information
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NPI Number | 1366055022
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Entity Type | Individual
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Provider Name | KELLY VIRGINIA TROUTMAN FNP
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Gender | Female
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 947 S 5TH ST
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City | MONTROSE
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State | CO
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Zip | 81401-5716
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Country | US
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Telephone | 907-249-2421
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Fax |
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Provider Business Mailing Address
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Address Line | 516 SPRING CREEK RD
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City | MONTROSE
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State | CO
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Zip | 81403-3326
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Country | US
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Telephone | 240-422-6206
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RXN.0106140
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APN.0996994-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN1056125
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.1670863
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License Number State | CO
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