Provider Demographics
NPI:1972493674
Name:WILSON, KELLY G (FDNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:G
Last Name:WILSON
Suffix:
Gender:F
Credentials:FDNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 TUNDRA CIR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-4040
Mailing Address - Country:US
Mailing Address - Phone:303-204-1600
Mailing Address - Fax:
Practice Address - Street 1:2077 TUNDRA CIR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-4040
Practice Address - Country:US
Practice Address - Phone:303-204-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005649227900000X
CO171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered