Provider Demographics
NPI:1902187768
Name:SCHMIDT, KELLY THERESA-COLGAN (MSN, WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:THERESA-COLGAN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:THERESA
Other - Last Name:COLGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RNC
Mailing Address - Street 1:2500 S HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1618
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:2500 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1618
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991295-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48256021Medicaid
CO025836OtherKAISER COMMERCIAL NUMBER
CO48256021Medicaid