Provider Demographics
NPI:1417776881
Name:KALLIO, LORY-ANNE JESSIE (FNP)
Entity type:Individual
Prefix:
First Name:LORY-ANNE
Middle Name:JESSIE
Last Name:KALLIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3572 MALDIVES DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3898
Mailing Address - Country:US
Mailing Address - Phone:843-743-5042
Mailing Address - Fax:
Practice Address - Street 1:3572 MALDIVES DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3898
Practice Address - Country:US
Practice Address - Phone:843-743-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily