Individual
KELLY JEAN BLEAKNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
106 BLANCA AVE, ALAMOSA, CO 81101-2340
(719) 589-2511
Mailing address
4810 SIERRA VISTA RD, ALAMOSA, CO 81101-8900
(719) 850-0666
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0161722
CO
363LF0000X
Family Nurse Practitioner
Primary
APN.0996244-NP
CO
Other
Enumeration date
03/09/2020
Last updated
02/11/2021
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