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General NPI Number Information
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NPI Number | 1396227864
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Entity Type | Individual
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Provider Name | KELLY KORTE NP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 2750 BROADWAY ST
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City | BOULDER
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State | CO
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Zip | 80304-3573
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Country | US
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Telephone | 303-440-3200
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Fax | 303-440-3232
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Provider Business Mailing Address
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Address Line | 660 MANORWOOD LN
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City | LOUISVILLE
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State | CO
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Zip | 80027-3240
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Country | US
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Telephone | 618-882-6000
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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 | 0993968-NP
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License Number State | CO
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