Provider Demographics
NPI:1306100888
Name:BORDEN, KELLY CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINE
Last Name:BORDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD195692085R0202X
KS04-411462085R0202X
NE306332085R0202X
390200000X
CO585732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026277600Medicaid
NE10026277800Medicaid
NENA2517104OtherMEDICARE
CO584657YQ33OtherMEDICARE
CO9000148903Medicaid
NE10026277500Medicaid
NE10026277700Medicaid
CO584657YQPGOtherMEDICARE
CO584657ZLJ3OtherMEDICARE
CO584657ZNTBOtherMEDICARE
NE84059792913Medicaid
NENA1214131OtherMEDICARE
NENA1215132OtherMEDICARE
NE10026277400Medicaid
NE10025709000Medicaid
CO584657YQN9OtherMEDICARE
NE84089712600Medicaid
NE10026277300Medicaid