Provider Demographics
NPI:1871213629
Name:BERGSTEDT, KELLY MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:BERGSTEDT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1899 DENVER WEST DR APT 1424
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3137
Mailing Address - Country:US
Mailing Address - Phone:707-362-0514
Mailing Address - Fax:
Practice Address - Street 1:1899 DENVER WEST DR APT 1424
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3137
Practice Address - Country:US
Practice Address - Phone:707-362-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0997967-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health