Provider Demographics
NPI:1124445051
Name:KELSO, AMY A (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:KELSO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172263
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-2263
Mailing Address - Country:US
Mailing Address - Phone:720-441-4021
Mailing Address - Fax:720-360-1195
Practice Address - Street 1:701 E HAMPDEN AVE STE 110
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:720-441-4021
Practice Address - Fax:720-360-1195
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003897363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant