Provider Demographics
NPI:1215087499
Name:BUSBY, KELLY A C (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A C
Last Name:BUSBY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 1780
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-1780
Mailing Address - Country:US
Mailing Address - Phone:970-565-8556
Mailing Address - Fax:970-564-1134
Practice Address - Street 1:33 N ELM ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3105
Practice Address - Country:US
Practice Address - Phone:970-565-8556
Practice Address - Fax:970-564-1134
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO42863207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1215087499OtherNPI