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Individual

SAMANTHA KELLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
4036 RIDGE DR, PUEBLO, CO 81008-1720
(719) 251-1594
(514) 236-8737
Mailing address
4036 RIDGE DR, PUEBLO, CO 81008-1720
(719) 251-1594
(514) 236-8737

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95034970
CA
363LF0000X
Family Nurse Practitioner
337690
AZ
363LF0000X
Family Nurse Practitioner
95006818
CA
363LF0000X
Family Nurse Practitioner
Primary
APN.0995461-NP
CO

Other

Enumeration date
06/28/2017
Last updated
04/21/2026
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