Organization
BEWELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER E, KELLER DERAAD APRN (CEO)
(970) 829-1129
Entity
Organization
Contact information
Practice address
1315 OAKRIDGE DR STE 100, FORT COLLINS, CO 80525-7338
(970) 829-1129
(949) 655-8678
Mailing address
1315 OAKRIDGE DR STE 100, FORT COLLINS, CO 80525-7338
(970) 829-1129
(949) 655-8678
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063793289
—
OH
Enumeration date
04/18/2025
Last updated
05/14/2025
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