Provider Demographics
NPI:1386467330
Name:BAPTIST, KELLI (RN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BAPTIST
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 1:1675 GARDEN OF THE GODS RD STE 2044
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-9444
Mailing Address - Country:US
Mailing Address - Phone:719-578-3199
Mailing Address - Fax:719-578-3114
Practice Address - Street 1:1675 GARDEN OF THE GODS RD STE 2044
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-9444
Practice Address - Country:US
Practice Address - Phone:719-578-3199
Practice Address - Fax:719-578-3114
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1670373163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse