=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811714454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELSEY LEE BENJAMIN NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2024
-----------------------------------------------------
Last Update Date | 07/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 S FRONTAGE RD W STE 5800
-----------------------------------------------------
City | VAIL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81657-5038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-926-6340
-----------------------------------------------------
Fax | 970-926-6348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4330
-----------------------------------------------------
City | EDWARDS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81632-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-926-6340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APN.1002129-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------