Individual
KELLY JEAN CUSHING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4747 ARAPAHOE AVE, BOULDER, CO 80303-1133
(303) 415-7610
(303) 415-7618
Mailing address
PO BOX 9049, BOULDER, CO 80301-9049
(303) 415-7610
(303) 415-7618
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DO27740
OR
207Q00000X
Family Medicine Physician
DR.0056124
CO
207QA0401X
Addiction Medicine (Family Medicine) Physician
DR.0056124
CO
208M00000X
Hospitalist Physician
Primary
DR.0056124
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500622186
—
OR
Enumeration date
07/09/2006
Last updated
11/25/2024
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