Individual
KELLIE ANN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
5007234
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
993170
NURSE PRACTITIONER - APN LICENSE
CO
Enumeration date
10/29/2013
Last updated
07/22/2022
Update your record
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