Individual
MRS. KELLY ANN PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10103 RIDGEGATE PKWY 312, LONE TREE, CO 80124-5525
(303) 788-8888
(303) 790-2567
Mailing address
10103 RIDGEGATE PKWY 312, LONE TREE, CO 80124-5525
(303) 788-8888
(303) 790-2567
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2166
CO
363AM0700X
Medical Physician Assistant
Primary
2166
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96585340
—
CO
Enumeration date
04/07/2006
Last updated
03/28/2016
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