Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 42863 | CO |
Y | 207Q00000X | Family Doctor | 42863 | CO |
NPI | 1215087499 |
---|---|
Provider Name | Dr. Kelly A. C. Busby |
First Address | Cortez, CO 81321-1780 |
Second Address | Cortez, CO 81321-3105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 28/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215087499 | NPI (01) | CO |