Organization
KELLY GILKERSON CRNA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY GILKERSON (CRNA)
(970) 302-4628
Entity
Organization
Contact information
Practice address
933 SELL AVE UNIT B, CANON CITY, CO 81212-4955
(719) 275-6433
Mailing address
423 GREENHORN DR, CANON CITY, CO 81212-9683
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
999999999
STILL PENDING
—
Enumeration date
11/08/2021
Last updated
11/08/2021
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