Individual
SUSAN JEAN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
326 8TH STREET, HUGO, CO 80821
(719) 743-2526
Mailing address
P.O. BOX 125, 326 8TH STREET, HUGO, CO 80821
(719) 743-2526
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
63693
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013048495
NPPES
CO
Enumeration date
03/22/2012
Last updated
08/01/2013
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