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General NPI Number Information
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NPI Number | 1710910831
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Entity Type | Individual
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Provider Name | KELLY JEAN CUSHING D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 4747 ARAPAHOE AVE
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City | BOULDER
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State | CO
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Zip | 80303-1133
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Country | US
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Telephone | 303-415-7610
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Fax | 303-415-7618
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Provider Business Mailing Address
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Address Line | PO BOX 9049
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City | BOULDER
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State | CO
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Zip | 80301-9049
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Country | US
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Telephone | 303-415-7610
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Fax | 303-415-7618
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | DR.0056124
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO27740
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | DR.0056124
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0056124
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License Number State | CO
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