Basic Information
Provider Information
NPI: 1558767426
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCKELVEY
FirstName: ELIZABETH
MiddleName: ELSIE
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 110429
Address2:  
City: AURORA
State: CO
PostalCode: 800420429
CountryCode: US
TelephoneNumber: 7204937000
FaxNumber:  
Practice Location
Address1: 13123 E 16TH AVE
Address2:  
City: AURORA
State: CO
PostalCode: 800457106
CountryCode: US
TelephoneNumber: 7207774596
FaxNumber: 7207777892
Other Information
ProviderEnumerationDate: 11/05/2014
LastUpdateDate: 07/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XAPN.0991434-NPCON Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
363LA2100XAPN.0991434-NPCOY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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