MEDICARE: MR. KYLE B KELLY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1932250636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYLE B KELLY

Provider Business Mailing Address
First Line	:	899 N LOGAN ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3155
Country	:	US
Telephone Number	:	303-429-5099
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 N LOGAN ST STE 300
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3155
Country	:	US
Telephone Number	:	303-429-5099
Fax Number	:	303-455-3661

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	01/11/2022

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