MEDICARE: DR. KELLY ANN PRICE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	DR.0059863	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DR.0059863	OTHER	CO	LICENSE

General Provider Information

NPI Number	:	1417012261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ANN PRICE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	719-576-5437
Fax Number	:	719-576-5441

Provider Business Practice Location Address
First Line	:	1230 TENDERFOOT HILL RD STE 255
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906
Country	:	US
Telephone Number	:	719-576-5437
Fax Number	:	719-576-5441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	02/18/2025

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