Provider Demographics
NPI:1114552734
Name:CHRISTIAN, KELLY E (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:E
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAIN ST SUITE 200
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641
Mailing Address - Country:US
Mailing Address - Phone:970-878-9524
Mailing Address - Fax:970-675-2381
Practice Address - Street 1:200 MAIN ST SUITE 200
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641
Practice Address - Country:US
Practice Address - Phone:970-878-9524
Practice Address - Fax:970-675-2381
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0177020163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse