MEDICARE: KELLY ANN DAVIS RN

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	163WP2201X	Ambulatory Care Registered Nurse	0172013	CO

General Provider Information

NPI Number	:	1780432211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN DAVIS RN

Provider Business Mailing Address
First Line	:	4331 TROUT CREEK RD
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-8424
Country	:	US
Telephone Number	:	719-201-7284
Fax Number	:

Provider Business Practice Location Address
First Line	:	565 SPACE CENTER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-3609
Country	:	US
Telephone Number	:	719-201-7284
Fax Number	:

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

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	05/09/2024

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