Individual
ERIC WILLIAM KELLEHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1024 S LEMAY AVE, FORT COLLINS, CO 80524-3929
(303) 306-7783
(303) 306-7753
Mailing address
PO BOX 912215, DENVER, CO 80291-2215
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0003079
CO
363AM0700X
Medical Physician Assistant
PA.0003079
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82328820
—
CO
Enumeration date
12/18/2007
Last updated
10/27/2023
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